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AF | PDBR | CY2012 | PD2012 01773
Original file (PD2012 01773.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201773
BRANCH OF SERVICE: Army  BOARD DATE: 20130404
SEPARATION DATE: 20030213


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (56M10/Chaplain Assistant) medically separated for vocal cord dysfunction (VCD). She was maintained on a P2 profile until January 2002. She was treated, but did not improve adequately to fully perform her military duties or meet physical fitness standards. The CI underwent a Medical Evaluation Board (MEB). The VCD condition was found medically unacceptable, and was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB found the VCD condition unfitting, and rated it 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI accepted the PEB findings and was medically separated with a 0% disability rating.


CI CONTENTION: “Vocal cord dysfunction causes anxiety attacks & worsens with PTSD attacks. Pes Planus/Plantar Fasciitis – still receiving treatment; private.” sic


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting VCD is addressed below. No other conditions are within the Board’s purview. Any conditions or contention not requested in the application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Army Board for Correction of Military Records.


 RATING COMPARISON :

Army PEB – dated 20040211
 VA - (one month Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Vocal Cord Dysfunction 6599-6520 0% Exercise Induced Asthma,
with Laryngospasm 		6520-6516 10% 20030127
No Additional MEB/PEB Entries
 Other x 1 20030108
Combined: 0%
 Combined: 20%
The original VARD dated 20030611, which was most proximate to date of separation , reflected the one unfitting cond i tion in a deferred status . The VARD dated 20030708 reflects the unfitting condition with an applicable VA rating .


ANALYSIS SUMMARY:

Vocal Cord Dysfunction (VCD). In 1998, the CI was diagnosed with VCD after laryngoscopy showed adduction of vocal cords on inspiration. A repeat laryngoscopic exam was normal. The CI was evaluated by multiple specialists; including pulmonology, speech therapy, psychology, otolaryngology, cardiology, and neurology. In spite of her evaluation and treatment, the symptoms persisted and a MEB was initiated. The MEB clinical examination performed in
May 2002. At that time, she complained of shortness of breath on exertion. Physical examination revealed an intrauterine pregnancy. Oral mucosa was normal. Lungs were clear, with decreased breath sounds due to “poor effort.” Pulmonary function tests showed a forced expiratory volume in one second (FEV-1) that was 88% of predicted.

Pulmonary Function
 MEB ~ 8 Mo s . Pre- Sep
(200 20530 )
FEV1 (% Predicted)
 8 8 %
FEV1/FVC
 87%

On 27 January 2003, the CI had a VA C ompensation and P ension (C&P) exam , a month prior to separation from service. She reported having “ s pells ” whenever she exercise d . These spells progress ed to panic attacks and made it difficult to breathe . She denied hoarseness, difficulty swallowing , or allergies. Exam of the oral cavity showed non-inflamed pharynx, n o pharyngeal mass or lesions , normal epiglottis, and good movement of the voc al cords . There was minimal swelling of cervical lymph nodes . The d iagnosis was exercised-induced asthma with laryngospasm , and syncopal episodes associated with anxiety attacks.

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The PEB used VASRD code 6599-6520 (condition analogous to laryngeal stenosis) and assigned a rating of 0%, since the FEV-1 and flow volume loop were normal. The VA coded the condition as 6520-6516 and assigned a rating of 10% based on the January 2003 C&P exam. The Board determined that the PEB had coded the condition appropriately, since the VCD was a laryngeal condition that produced narrowing of the laryngeal airway. The Board then determined that a rating of 0% was appropriate, since the FEV-1 and flow volume loop were normal. The Board tried to find a path to a rating higher than 0%, using other codes which could be applied to the VCD condition. The other VASRD codes that were considered did not result in a rating higher than 0%, since the treatment record did not show sufficient clinical evidence which would justify a rating higher than 0%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the VCD condition.


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 VCD, and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication. 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
Vocal Cord Dysfunction 6599-6520 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121001, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010301 (PD201201773)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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