RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
BRANCH OF SERVICE:  NAVY 
NAME:    
DATE OF PLACEMENT ON TDRL:  20000121 
CASE NUMBER:  PD1100774 
BOARD DATE: 20121004                                           DATE OF PERMANENT SEPARATION:  20050519 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PR3/E-4 (Aircrew Survival Equipmentman Third Class), 
medically  separated  for  a  chronic  left  lung  condition.    He  did  not  respond  adequately  to 
treatment  and  was  unable  to fulfill  the  physical  demands  within his  Rating,  meet  worldwide 
deployment standards or meet physical fitness standards.  He was placed on limited duty and 
underwent a Medical Evaluation Board (MEB).  Severe pulmonary coccidioidomycosis left lung 
was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  Three other 
conditions, identified in the rating chart below, were also identified and forwarded by the MEB.  
The CI was placed on Temporary Disability Retired List (TDRL) with ratings as reflected in the 
chart below.  The PEB adjudicated the chronic left lung condition as unfitting, rated 10%, five 
years after being placed on TDRL, with application of the Veteran’s Affairs Schedule for Rating 
Disabilities  (VASRD).    The  CI  made  no  appeals,  and  was  medically  separated  with  a  10% 
disability rating.   
 
 
CI  CONTENTION:    The  final  TDRL  report  examination  dated  14  Dec  2004  states  under  (Final 
Diagnosis):  The board recommends transfer of the member to the Permanent Disability List.  
Then,  3  months  later,  dated  18  Mar  2005  in  the  findings  of  the  PEB  proceedings  under 
(diagnosis & ratings) I was to be separated from TDRL with a 10% rating. 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    Any  conditions  or  contention  not 
requested in this application, or otherwise outside the Board’s defined scope of review, remain 
eligible for future consideration by the Board for Correction of Naval Records (BCNR).   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

VA* – All Effective Date 20000120 

Condition 

Code 

Rating 

Exam 

Coccidial Mycosis, S/P 
Decortication 

6835 

50%* 

20000616 

TDRL RATING COMPARISON: 
 

Service PEB  – Dated 20050318 

Rating 

Condition 
On TDRL – 
200XXXXX 

Severe Pulmonary 
Coccidioidomycosis 

Code 

 

6835-6899-

6829 

Left Thoracotomy 
with Decortication  

Chronic 
costalchondritis 

 

 

Autosomal-
Dominant Polycystic 
Kidney Disease 

Preexisting 
Condition 

 

Combined:  10% 

Sep. 

10% 
MEB 
entry,N

ot 

adjudic
ated 
MEB 
entry, 
Not 
adjudic
ated 

TDRL 

50% 
Not 
ident
ified 
by 
MEB 
Not 
inden
tified 
by 
MEB 

EPTE 

Costochondritis of 
L/Anterior Rib Cage 

EPTE 

Polycystic Kidney Disease 

Anterior Cruciate 
Ligament Tear of L/knee, 
S/P Repair 

5299-5291 

0% 

20000616 

 

7533 

 
0% 

20000616 

5299-5257 

10% 

20000616 

Not Service Connected x 1 

Combined:  60% 

20000616 

*VARD 20110915 decreased rating to 0% effective 20111201 for failure to report to VA exam 
 
 
ANALYSIS  SUMMARY:    The  Board  acknowledges  the  CI’s  assertions  that  the  final  TDRL  MEB 
recommended  that  he  be  transferred  to  the  TDRL;  however,  3  months  later  the  PEB 
recommendation was to separate for 10%.  It is noted for the record that the Board has neither 
the jurisdiction nor authority to scrutinize or render opinions in reference to asserted service 
improprieties in the disposition of a case.  The Board’s role is confined to the review of medical 
records and all evidence at hand to assess the fairness of PEB rating determinations, compared 
to VASRD standards, based on severity at the time of separation.  It must also judge the fairness 
of PEB fitness adjudications based on the fitness consequences of conditions as they existed at 
the time of separation.   
 
Chronic left lung condition.  In October 1998, the CI sought treatment for fevers, chills, night 
sweats,  left  pleuritic  chest  pain  and  weight  loss.    He  was  admitted  and  treated  for  a 
presumptive diagnosis of pneumonia with a chest X-Ray demonstrating a left lung infiltrate and 
effusion of the lower lobe.  A chest computer tomography (CT) further revealed a left lower 
infiltrate  and  a  large  pleural  effusion,  extensive  lympadenopathy,  bilateral  renal  masses  and 
splenomegaly.    He  was  transferred  to  a  different  hospital  and  underwent  an  extensive 
evaluation by urology, infectious disease, cardiology, and surgery.  He had multiple procedures 
to include bronchoscopy, thoracentesis, and finally underwent a thoracotomy (surgical incision 
into  the  lung  space)  with  a  left  lung  decortication  procedure  (removal  of  the  pleural  lining), 
three chest tube placements to remove the fluid from his lung, 5-6 blood transfusions, and a 
lumbar  puncture  (LP)  which  required  a  6  day  ICU  stay.    He  had  a  negative  LP  for 
coccidioidomycosis.    He  remained  in  the  hospital  for  8  more  days  and  was  treated  with  the 
antifungal  medication,  Diflucan  (Fluconazole)  and  a  narcotic  based  pain  medication.    He 
responded  well  with  abatement  of  fever,  chills,  and  cough,  but  continued  to  have  pleuritic 
chest pain.  On discharge he was diagnosed with severe dissemeniated coccidioidomycosis and 
autosomal dominant polycystic kidney disease.  By May 1999 he had not regained his weight 
and had unfavorable trend of his serology’s and increasing pleuritic chest pain.  Another chest 
CT  revealed  a  reaccumulation  of  pleural  fluid  necessitating  another  thoracentesis  and 
prolonged treatment with a catheter in the pleural space with noted slight improvement of his 

   2                                                           PD1100774 
 

chest pain.  He was continued on his antifungal medication as well as narcotic pain medication 
and underwent a MEB in August 1999.  The non-medical assessment (NMA) documented the CI 
was not working in his Rating, was missing 25 hours of work a week for medical appointments, 
that his medical condition was unstable and documented he was no longer physically capable 
of performing his rating ashore or afloat. 
 
The first MEB exam demonstrated a well-healed throacotomy incision and a healing chest tube 
insertion  site,  clear  lungs,  no  hepatosplenomegaly  and  a  coccidioidomycosis  compliment 
fixation titer of 1:32 (normal <2).  The examiner opined the CI would require prolong antifungal 
medication  for  minimum  of  2  years  and  depending  on  the  response  may  be  life  long,  and 
further  documented  relapse  of  this  condition  was  40%  off  medication.   The examiner  stated 
until  the  stability  of  his  disease  was  proven,  he  was  not  worldwide  qualified.    At  the  VA 
Compensation  and  Pension  (C&P)  exam,  performed  7  months  after  TDRL  placement,  the  CI 
reported a similar historical account and symptoms of non-progressive dyspnea, chest pain 3/4 
of 10 in intensity, increased with inspiration, climbing or walking, left rib chest pain 50% of the 
day,  daily headaches  which  he  attributed  to  Diflucan  and  that  he  continued  to  take  narcotic 
pain medication.  His weight was stable, appetite was fair, and he did not report cough, night 
sweats, fever or chills.  He also reported he was not working.  The exam demonstrated similar 
findings as in the MEB.  Pulmonary function tests (PFT) before bronchodilator revealed a FEV1 
of 3.87 which was 67% of predicted and after bronchodilator an FEV1 of 4.64, 87% of predicted.  
The  examiner  diagnosised  coccidioidomycosis,  currently  under  chronic  treatment  previously 
treated with decortication of the left lung, chronic pleuritic pain of the left posterior rib cage 
and costochondritis of the left anterior rib cage. 
 
Subsequently, the CI had two TDRL exams prior to the final exam at the time of separation.  The 
exams  documented  improving  weight,  negative  serology  titers  for  coccidiomycosis  yet 
continued symptoms of dyspnea on exertion (DOE), chest pain and headaches.  By his second 
exam he had a new onset of night sweats that had not been clarified as to an etiology by his 
final exam.  At the final TDRL MEB exam, the CI reported no improvement.  He continued to 
have constant left chest pain, 4/5 of 10 in intensity, worst with exertion and at its worst 5/6 of 
10 in intensity.  He required daily medication to control his pain to include chronic nonsteroidal 
medication, non narcotic medication and intermittent narcotic medication when the pain was 
the worst.  He had DOE with two flights of stairs, had new night sweats that occurred one to 
two times per week for the past 2 years and continued to have an intermittent nonproductive 
cough.  His weight was stable and he reported seeing an infectious disease physician every 2 
months.  The exam demonstrated a weight of 210 pounds, a well-healed left thoracotomy scar 
and tenderness over the left lower anterior chest wall, coccidioides antibody IGG by enzyme 
immunoassay  was  negative  and  PFT’s  were  improved  from  the  prior  exam  with  overall 
demonstration of normal lung volumes and flow.  The examiner diagnosed severe pulmonary 
coccidioidomycosis  with  resultant  chronic  pain  and  DOE  and  chronic  night  seats  of  unclear 
etiology possibly due to chronic coccidioidomycosis.  The examiner opined the CI’s chronic pain 
in  his  chest  was  caused  by  scarring  from  the  coccidioidomycosis  infection  which  required 
chronic oral narcotics for control and this was incompatible with return to active duty.  Further, 
his  chronic  dyspnea  prevented  him  from  performing  all  duties  of  his  rating.    There  were  no 
future VA exams for consideration. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB decision, transferring the CI to TDRL, and VA rating decision chose to use the code 6835 
(Coccidioidomycosis)  for  the  left  lung  condition  IAW  §4.97—schedule  of  ratings–respiratory 
system  under  general  rating  formula  for  mycotic  lung  disease  at  the  50%  rating.    All  Board 
members  considered  and  agreed  the  evidence  meets  the  50%  rating  criteria  at  the  time  of 
placement on TDRL which specifically states “chronic pulmonary mycosis requiring suppressive 
therapy  with  no  more  than  minimal  symptoms  such  as  occasional  minor  hemoptysis  or 

   3                                                           PD1100774 
 

productive  cough”  and  further  agreed  the  evidence  did  not  meet  the  100%  criteria  which 
specifically states “chronic pulmonary mycosis with persistent fever, weight loss, night sweats, 
or massive hemoptysis.”  At the time of the final TDRL MEB exam the PEB chose to rate with the 
primary code 6829 (Drug-induced pulmonary pneumonitis and fibrosis) analogous to the 6899 
code and the 6835 code ,respectively and rated 10% based on normal PFT’s with residual chest 
pain  and  dyspnea  on  exertion.    The  Board  agreed  the  evidence  does  not  reflect  any  clinical 
reference to the criteria of the 6829 code and therefore the Board did agreed not to consider 
this  code  in  its  permanent  rating  recommendation.    The  Board  agreed  the  clinical  evidence 
predominantly reflects a diagnosis of coccidioidomycosis and its residuals and therefore agreed 
to  rate  with  the  clinically  specific  6835  code.    The  final  TDRL  exam  reflects  completion  of 
antifungal  medication  and  residuals  of  pain,  DOE  night  sweats  of  unknown  etiology  and 
intermittent  nonproductive  cough.    The  Board  agreed  the  evidence  does  not  meet  the 
50%criteria as the CI is no longer on suppression medication but meets the 30% criteria which 
specifically  states  “chronic  pulmonary  mycosis  with  minimal  symptoms  such  as  occasional 
minor hemoptysis or productive cough.”  After due deliberation, considering all of the evidence 
and  mindful  of  VASRD  §4.3  (reasonable  doubt), the  Board  recommends  a  disability  rating  of 
30% for a final disability rating.   
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were  exercised.    In  the  matter  of  the  chronic  left  lung  condition,  the  Board  unanimously 
recommends  a  final  disability  rating  of  30%  coded  5835  IAW  VASRD  §4.97.    There  were  no 
other conditions within the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

RATING 

PERMANENT 

30% 
30% 

VASRD CODE 

6835 

COMBINED 

UNFITTING CONDITION 
Severe Pulmonary Coccidioidomycosis 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110913, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 

 

   4                                                           PD1100774 
 

      
 

              COMMANDER, NAVY PERSONNEL COMMAND 
                                        

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS 
 
 
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS           
 
Ref:   (a) DoDI 6040.44 
          (b) PDBR ltr dtd 12 Oct 12 ICO   
          (c) PDBR ltr dtd 17 Oct 12 ICO   
          (d) PDBR ltr dtd 22 Oct 12 ICO   
                               
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review 
set forth in references (b) through (d). 
 
2.  The official records of the following individuals are to be corrected to reflect the stated disposition: 
 
 
Permanent Disability Retired List effective 18 March 2005. 

a.  former USN:  Disability retirement with a final disability rating of 30% with assignment to the 

 
b. former USMC:   Disability retirement with a final disability rating of 40% with assignment to 

the Permanent Disability Retired List effective 28 November 2008. 

 
c.   former USMC:  Disability retirement with a final disability rating of 30% and assignment to 

 

the Permanent Disability Retired List effective 15 March 2006. 
 
3.  Please ensure all necessary actions are taken, included the recoupment of disability severance pay if 
warranted, to implement these decisions and that subject members are notified once those actions are 
completed. 
 
 
 
 
 
 

   

 

 

 

 

 

   5                                                           PD1100774