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AF | PDBR | CY2013 | PD2013 00125
Original file (PD2013 00125.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xxxxxxxxxxxxxx     CASE: PD1300125
BRANCH OF SERVICE: Army  BOARD DATE: 20130827
SEPARATION DATE: 20081027


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92G/Food Service) medically separated for recurrent spontaneous pneumothorax (PTX). The CI had recurrent spontaneous PTX prior to service, and underwent surgery (pleurodesis) to correct the problem. She successfully enlisted and shortly thereafter, she deployed to Iraq. During the deployment, she experienced shortness of breath (SOB) and chest pain. She completed her deployment but continued to have pain when breathing and eventually could not pass her physical fitness test. Her condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). Two pulmonary conditions, characterized as “spontaneous pneumothorax, recurrent” and “pleurisy” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also forwarded four other conditions meeting retention standards (plantar fasciitis, adjustment disorder, patellar tendonitis, and cervicalgia). The PEB found the pulmonary condition unfitting and rated it 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The other conditions were determined to be not unfitting , except for the adjustment disorder, which the PEB consi dered as not compensable . The CI made no appeals and was medically separated.


CI CONTENTION: The CI stated a lengthy contention, specifically calling out her diagnosis and rating of PTSD (by the VA) and how her adjustment disorder should have been considered as such. She also claimed her pleurisy should have been separately rated and she disputed the fit findings for her other diagnoses as forwarded from the MEB to the PEB.


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 recurrent spontaneous (non-traumatic) pneumothorax condition (as well as the included pleurisy condition) is addressed below. The plantar fasciitis, patellar tendonitis, adjustment disorder, and cervicalgia, which were adjudicated by the PEB, are likewise addressed below. Any conditions not within the Board’s scope of review may be eligible for future consideration by the Board for Correction of Military Records (BCMR).



 RATING COMPARISON :

Service IPEB – dated 20080924
 VA - (20 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Recurrent Spontaneous (Non-Traumatic) Pneumothorax 6699-6603 10% Residuals, Spontaneous Pneumothorax 6843 10% 20100616
Pneumothorax Scar 7804 10% 20100616
Left Patellar Tendonitis Not Unfitting Residuals, Left Knee Strain 5260 10% 20100616
Cervicalgia Not Unfitting Degenerative Joint Disease and Strain, Cervical Spine 5242 10% 20100616
Adjustment Disorder Not Compensable PTSD 9411 30% 20100601
Right Plantar Fasciitis Not Unfitting No Corresponding VA Entry for Plantar Fasciitis
No Additional MEB/PEB Entries
 Other x 8 20100616
Combined: 10%
 Combined: 70% (including bilateral factor for 5260)
Derived from VA Rating Decision (VA RD ) dated 20100817 ( most proximate to date of separation [ DOS ] )


ANALYSIS SUMMARY: The Board acknowledges the CI’s contention for ratings of her conditions noted above which were determined to be not unfitting by the PEB; and, emphasizes that disability compensation may only be offered for those conditions that cut short the member’s career. Should the Board judge that any contested condition was most likely incompatible with the specific duty requirements; a disability rating IAW the VASRD, and based on the degree of disability evidenced at separation, will be recommended. The Board further recognizes the CI’s assertions that her disability disposition was in error particularly with respect to her adjustment disorder diagnosis. It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations; and, redress in excess of the Board’s scope of recommendations must be addressed by the BCMR and/or the United States judiciary system.

Recurrent Pneumothorax (PTX). Prior to enlistment, the CI had two episodes of spontaneous PTX of the left chest. She underwent thoracoscopic pleurodesis, with resection of left apical blebs. She then entered military service in March 2006. After enlisting in the Army, she continued to have episodes of pain and SOB. In June 2008, the CI had a pulmonary evaluation at Tripler Army Medical Center. On physical exam (PE), the lungs were clear to auscultation with no wheezes, rhonchi or rales. Computerized tomography (CT) of the chest showed no PTX present. Pulmonary function tests (PFTs) revealed a forced expiratory volume in one second (FEV-1) that was 115% of predicted. Her FEV-1 divided by forced vital capacity (FVC) was 78%. The FEV-1 did not improve with bronchodilator. Methacholine challenge test was negative. In July 2008, she had another episode of acute chest pain. Chest CT showed a small left-sided PTX. Due to her recurrent problems with spontaneous PTX, an MEB was initiated. The MEB pulmonary evaluation on 16 July 2008 indicated that the lung PE was essentially normal, with good air movement, and no wheezing or rales. As noted above, the CI was found unfit for military service, and was medically separated from the Army in October 2008. In April 2010, 18 months after separation, she had a VA pulmonary consult. Lung PE was normal. Chest CT showed no PTX. FEV-1 was 104% of predicted. The FEV-1 divided by FVC was 87%. Diffusion capacity of the lung for carbon monoxide was 77%.

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Army PEB coded the PTX condition as 6699-6603 (analogous to emphysema), and assigned a rating of 10%. After a thorough review of the treatment record, the Board discussed at length VASRD §4.96 (special provisions regarding evaluation of respiratory conditions) and §4.97 (schedule of ratings – respiratory system). The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the PTX condition. The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling lung abnormality which would justify a higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the PTX condition.

Pleurisy. This condition was listed on DA Form 3947 and forwarded to the PEB for adjudication. The Army PEB combined the two lung problems into a single unfitting condition, coded 6699-6603 and rated at 10%. The Board evaluated whether or not it was appropriate for the two lung problems to be combined into a single unfitting condition. The Board must determine if the PEB’s approach of combining the conditions under a single rating was reasonably justified in lieu of separate ratings. After due deliberation, the Board agreed that the evidence did not support a conclusion that each of the lung conditions, separately, would have rendered the CI unable to perform her required military duties. Specifically, IAW VASRD §4.14 (avoidance of pyramiding), the pleurisy condition did not constitute a separately unfitting condition at the time of separation from service. Accordingly, the Board does not recommend a separate disability rating for pleurisy. It is reasonably justified for the two lung problems to be combined, and treated as a single unfitting condition. Therefore, the Board found insufficient cause to recommend a change in the PEB determination for the pleurisy condition.

Other PEB Conditions. Plantar fasciitis, patellar tendonitis, and cervicalgia (neck pain) were all adjudicated by the PEB as “not unfitting.” A mental disorder (adjustment disorder) was found to be “not compensable.” All of these other PEB conditions were reviewed and considered by the Board. There was not sufficient performance-based evidence in the record that any of these conditions significantly interfered with satisfactory duty performance. 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 determination for any of these conditions.

Other Conditions. In her application, the CI contended that posttraumatic stress disorder (PTSD) should be considered as a compensable condition. Adjustment disorder was listed by the MEB and addressed by the PEB (as a non-compensable condition within the Disability Evaluation System). Post-separation, the VA apparently changed this diagnosis to PTSD and rated the CI for this condition. The CI’s contention centered on claiming PTSD as a condition for which she should have been rated by the PEB. However, PTSD was not diagnosed prior to separation, and was not an MEB/PEB condition. Therefore, it is not within the Board’s defined purview. As noted above, any condition not within the Board’s scope of review may be eligible for consideration by the BCMR.


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 recurrent spontaneous PTX, and IAW VASRD §4.96 and §4.97, the Board unanimously recommends no change in the PEB adjudication. In the matter of the pleurisy, plantar fasciitis, patellar tendonitis, cervicalgia, and adjustment disorder, the Board unanimously recommends no change in the PEB determinations.


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
Recurrent spontaneous (non-traumatic) pneumothorax 6699-6603 10%
COMBINED
 10%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 1 30319 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





xxxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review



SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxx, AR20130021850 (PD201300125)


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                                                  xxxxxxxxxxxxxxxxxxxxxxxx
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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