RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201142 TDRL ENTRY DATE: 20020101 

BOARD DATE: 20130214 TDRL EXIT DATE: 20030206 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (25V/Combat Document Production 
Specialist), medically separated for radiation induced pulmonary fibrosis following treatment of 
Stage III-B Hodgkin’s disease. The CI did not improve adequately with treatment to meet the 
physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board 
(MEB). Stage III-B Hodgkin’s disease; evidence of radiation induced pulmonary fibrosis; chronic 
chest pain, status post (s/p) sternotomy; short of breath and dyspnea on exertion; 
environmental allergies; and history of fracture of the right fourth toe, 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. Following later re-
evaluation, the Physical Evaluation Board (PEB) adjudicated the radiation induced pulmonary 
fibrosis following treatment of Stage III-B Hodgkin’s disease as unfitting, rated 10%, 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 range of conditions I suffer from and the severity of the effects for 
residual effects of chemo and radiation limit me greatly. This I believe should have my rating at 
100%. My overall is 90% regardless of the 170% of disability determined. The effects of 
treatment has left (sic) me at current age 34, with stabbing sensations in legs and chest, 
difficulty breathing with aerobics activities, severe back pain, which in turn causes sciatica, 
CVID-an immune deficiency, scars and pain in chest from sternotomy. Not to mention upset 
stomach (currently being evaluated for my gallbladder) from pain medicine and a very poor self 
image.” The CI attached a lengthier one page statement pleading her application which was 
reviewed by the Board and considered in its recommendations. 

 

 

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. The Stage III-B Hodgkin’s disease; radiation 
induced pulmonary fibrosis; chronic chest pain, status post (s/p) sternotomy; and short of 
breath and dyspnea on exertion conditions requested for consideration meet the criteria 
prescribed in DoDI 6040.44 for Board purview, and are accordingly addressed below. 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 Army Board for 
Correction of Military Records. 

 

 

 

 

 

 


TDRL RATING COMPARISON: 

 

Service PEB – Dated 20030116 

VA* – All Effective Date 20020102 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

On TDRL – 20011016 

 

TDRL 

Sep. 

Radiation Induced 
Pulmonary Fibrosis 
Following Treatment Of 
Stage III-B Hodgkin's 
Disease … 

7709-
6830 

30% 

10% 

Pulmonary Fibrosis 
Secondary to Therapy for 
Stage III Hodgkin’s Disease 

6830 

10% 

20020131 

20040408 

Stage III Hodgkin’s Disease 
s/p … 

7709 

0% 

20020131 

20040408 

Chronic Chest Pain 

Not 
unfit 

Short of Breath & Dyspnea 
on Exertion 

Environmental Allergies 

Not Unfitting 

Sinusitis 

6511 

0% 

20020131 

History of Fracture of Rt 4th Toe 

Not Unfitting 

S/P Right 4th Toe Fracture 

5299-5284 

0% 

20020131 

.No Additional MEB/PEB Entries. 

Chronic Anxiety 

9413 

10% 

20020131 

Scars S/P Sternotomy 

7899-7804 

10% 

20020131 

20040408 

Neuropathy, 4th and 5th 
Fingers, Bilat Feet 

8599-8516 

10% 

20020131 

0% x 2/Not Service Connected x 5 

20020131 

Combined: 10% 

Combined: 30%* 



*VARD 20040408 did not change ratings on pulmonary fibrosis or painful scar conditions. VA increased combined rating with 
additional conditions added on 20090804 VARD 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which her service-incurred condition continues to 
burden her. It is a fact, however, that the Disability Evaluation System (DES) has neither the 
role nor the authority to compensate members for anticipated future severity or potential 
complications of conditions resulting in medical separation. This role and authority is granted 
by Congress to the Department of Veterans Affairs (DVA). The Board utilizes DVA evidence 
proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-
month interval for special consideration to post-separation evidence. The Board’s authority as 
defined in DoDI 6040.44, however, resides in evaluating the fairness of DES fitness 
determinations and rating decisions for disability at the time of separation. Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. 

 

Radiation Induced Pulmonary Fibrosis following treatment of Stage III-B Hodgkin’s Disease. The 
narrative summary (NARSUM) at TDRL entry noted that the CI was treated for Stage III 
Hodgkin’s disease with chemotherapy followed by radiation treatment. Evaluation at the time 
of the NARSUM indicated no evidence of disease (NED). At the MEB exam, about 13 months 
post completion of chemotherapy and radiation treatment, the CI reported difficulty with 
dyspnea on exertion (DOE) with activity such as walking briskly, and chest pain from the 
sternotomy, as well as palpitations and pounding heart beats with anxiety and easy fatigability. 
The MEB examiner (a pulmonologist) noted a mid-sternal scar, but the exam was otherwise 
normal, including the pulmonary exam. CT scan from 6 months earlier showed a mediastinal 
mass that was smaller than previously and radiation induced interstitial changes. 
Echocardiogram showed a small pericardial effusion, not hemodynamically significant. 
Pulmonary function tests (PFTs) showed evidence of mild restriction, with an FVC of 66% 
predicted normal and a normal diffusing capacity (DLCO). Cardiopulmonary stress testing was 
suggestive of deconditioning and a restrictive process with a maximal exercise capacity (VO2) of 
1.18 liters. The diagnoses were Stage-III Hodgkin’s disease, with apparent cure; radiation 
induced pulmonary fibrosis; chronic chest pain, status post sternotomy; short of breath (SOB) 
and DOE; environmental allergies; history of fracture of right fourth toe. The examiner’s 


opinion was that the CI’s significant DOE was multifactorial including treatment residuals and 
deconditioning. He also stated that “Given the amount of her pain and impairment” she would 
be unable to perform the duties associated with her MOS. She was referred to the PEB due to 
pulmonary fibrosis and other conditions including restrictive defect and chronic chest pain 
status post sternotomy which limited her ability to engage in exercise and physical exertion. 
The PEB placed the CI on TDRL with a 30% rating because her condition was not stable enough 
for final adjudication. 

 

At the TDRL re-evaluation exam, the CI reported that there had been improvement in her chest 
pain but she still had DOE with some activities. She was not on any medication for these 
conditions. The MEB physical exam noted the CI was in no apparent distress with a normal 
respiratory rate and normal oxygen saturation on pulse oximetry. The chest was noted to be 
post median sternotomy; lungs were clear with equal breath sounds bilaterally and good air 
movement. There were no abnormalities noted on the remainder of the exam. Chest X-ray 
and chest CT scan were done the same day and showed post-surgical changes and fibrosis of 
the left upper lobe and anterior mediastinum. PFTs in October 2002 showed an FVC of 77% 
predicted normal, and a normal DLCO. The interpretation of the PFTs was mild restrictive 
disease confirmed by lung volumes and a normal DLCO and stable. In the summary of the CI’s 
present condition, the examiner stated “Over the course of the past year, her chest pain has 
improved. This has allowed her to increase her activities and help correct part of her 
component of deconditioning. However, she still remains with restrictive lung disease.” The 
diagnoses were Hodgkin’s Disease post treatment with apparent cure; radiation induced 
pulmonary fibrosis; persistent DOE; and environmental allergies. 

 

At the initial VA Compensation and Pension (C&P) exam, about a month after TDRL entry, the CI 
reported DOE and dizziness, with change of positions. This was opined to be treatment related 
by her treating physicians. She also complained of numbness and tingling of both legs and to 
her fourth and fifth fingers of her hands. This was attributed to radiation and chemo effects as 
well. On exam, multiple chest scars were noted. The lungs were clear. Neurological and 
musculoskeletal exams were normal. Chest X-rays showed post-surgical changes, lungs were 
clear with minimal bi-apical scar. PFT showed an FVC of 80% predicted normal. At a C&P exam 
about 14 months post separation the CI complained of DOE. Lung exam was normal. Chest X-
rays showed no active disease. (PFTs were done but no results are in the record.) PFTs were 
noted to be normal one year earlier. The chest wall and scar exam was unchanged from the 
prior VA exam noted above. 

 

The Board directs attention to its rating recommendation based on the above evidence. At 
TDRL entry the PEB adjudicated the combined diagnoses of Stage-III Hodgkin’s Disease; 
pulmonary fibrosis; chest pain post sternotomy; and SOB/DOE as unfitting, rated as 7709-6830 
at 30% and placed the CI on TDRL. The VA rated 6830 (pulmonary fibrosis secondary to therapy 
for Stage-III Hodgkin’s Disease) at 10% and 7899-7804 (scar status post-sternotomy) at 10%, as 
well as multiple other conditions not adjudicated by the PEB, and therefore not within the 
Board’s scope IAW DoDI 6040.44, as previously noted. 

 

Rating criteria for 6830 (radiation induced pulmonary pneumonitis and fibrosis) are based on 
the VASRD General Rating Formula for Interstitial Lung Disease and are: PFT results of FVC; 
DLCO; and for the higher ratings, maximal exercise capacity. The PEB bundled the MEB 
diagnoses of Hodgkin’s Disease with apparent cure; pulmonary fibrosis; chest pain post 
sternotomy; and SOB/DOE and provided one rating. The Board agreed this was a reasonable 
approach to rating the CI’s disability based on the listed diagnoses as it was not possible to 
separate the restrictive effects of pain or limited chest wall movement post sternotomy on 
pulmonary function from the effect of pulmonary fibrosis. The VA rated a painful scar on the 
right chest at 10%. The chronic chest pain referred to in the NARSUM was referring to pain due 
to post-operative pain of the still healing chest wall post-sternotomy, not a painful scar. The 


NARSUM addendum lists complications including restrictive lung defect secondary to 
sternotomy and local chest wall pain with inspiration/expiration. The Board adjudged that 
there is insufficient evidence in the record to support the painful scar on the right chest wall as 
a separately unfitting condition. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (reasonable doubt), and VASRD §4.14 (avoidance of pyramiding), the 
Board concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the radiation induced pulmonary fibrosis, secondary to treatment for Stage-III-
B Hodgkin’s disease, currently NED, with chest pain post sternotomy and DOE condition at the 
time of TDRL entry. 

 

At the end of TDRL, the PEB adjudicated the radiation induced pulmonary fibrosis following 
treatment of Stage-III-B Hodgkin’s disease as unfitting, coded 7709-6830 at 10%. The PEB 
found the conditions of chest pain post sternotomy and SOB/DOE to be not unfitting as they 
had improved during the period of TDRL. The VA continued ratings of 6830 (pulmonary fibrosis 
secondary to) at 10% and 7899-7804 (scar status post-sternotomy) at 10%. At the time of 
separation, the CI’s PFTs had improved with an FVC of 77% predicted normal and therefore the 
PEB rated the CI’s condition at the time of separation as 7709-6830 at 10%. The Board 
deliberated whether IAW VASRD §4.96 (Special provisions regarding evaluation of respiratory 
conditions) the disability of the combined effects of chest pain post-sternotomy and pulmonary 
fibrosis met the criteria for elevation to the next higher evaluation of 30%. The Board opined 
that post-sternotomy chest pain was not a separate respiratory condition and any impact with 
pulmonary restriction was considered under the CI’s unfitting pulmonary fibrosis condition and 
therefore, the next higher evaluation was not supported. 

 

The CI’s PFT’s fell within the FVC of 75% to 80% predicted range and met the 10% rating criteria 
under the General Rating Formula for Interstitial Lung Disease. After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and IAW VASRD 
§4.97, the Board concluded that there was insufficient cause to recommend a change in the 
PEB adjudication for the radiation induced pulmonary fibrosis, secondary to treatment for 
Stage-III-B Hodgkin’s disease condition at the time of separation. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
at the end of TDRL were chest pain post-sternotomy and SOB/DOE conditions. The Board’s first 
charge with respect to these conditions is an assessment of the appropriateness of the PEB’s 
fitness adjudications. The Board’s threshold for countering fitness determinations is higher 
than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but 
remains adherent to the DoDI 6040.44 “fair and equitable” standard. The TDRL re-evaluation 
NARSUM stated the CI’s chest pain had improved. The CI offered no complaint regarding the 
chest pain at the exam. The CI’s DOE had originally been described as “multifactorial” due to 
deconditioning and significant contributions from chest pain and pulmonary fibrosis. At the re-
evaluation exam it was noted that the CI had improved exertional dyspnea, her chest pain had 
improved allowing more activity and consequently improved conditioning. The record supports 
that the conditions of chest pain post sternotomy and DOE had improved between TDRL entry 
and re-evaluation and were reasonably found to be not unfitting at the time of separation. 
After due deliberation in consideration of the preponderance of the evidence, the Board 
concluded that there was insufficient cause to recommend a change in the PEB fitness 
determination for the either of the contended conditions; and, therefore, no additional 
disability ratings can be recommended. 

 

 

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 radiation induced pulmonary fibrosis following treatment 
of Stage III-B Hodgkin’s disease condition with consideration of chest pain post sternotomy and 
dyspnea on exertion conditions the Board unanimously recommends no change in the PEB’s 
30% TDRL entry adjudication. In the matter of the radiation induced pulmonary fibrosis 
following treatment of Stage III-B Hodgkin’s disease condition the Board unanimously 
recommends no change in the PEB’s 10% permanent separation adjudication at TDRL exit. In 
the matter of the contended chest pain post sternotomy and shortness of breath/dyspnea on 
exertion conditions, at TDRL exit, the Board unanimously recommends no change from the PEB 
determinations as not unfitting. There were no other conditions within the Board’s scope of 
review for consideration. 

 

 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

PERMANENT 

Radiation Induced Pulmonary Fibrosis Following 
Treatment of Stage III-B Hodgkin’s Disease 

7709-6830 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120703, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


 

SFMR-RB 

 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxx, AR20130003961 (PD201201142) 

 

 

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD 
PDBR) recommendation and record of proceedings pertaining to the subject individual. Under 
the authority of Title 10, United States Code, section 1554a, I accept the Board’s 
recommendation and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Revier Boards)