RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1300029
BRANCH OF SERVICE:  Army	BOARD DATE:  20130516
SEPARATION DATE:  20050326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty/activated National Guard/Air National Guard/Reserve SSG/E-6 (15H/AFSC, JOB) medically separated for Kartagener’s Syndrome (KS) with chronic sinusitis.  The CI developed multiple upper respiratory infection symptoms while deployed to Operation Iraqi Freedom.  The condition would improve with empiric treatment, and deteriorate without treatment.  The CI was evacuated from the area of responsibility to Germany for treatment.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The KS with chronic sinusitis condition(s), characterized as “medically unacceptable” and “EPTS” was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The IPEB adjudicated KS with chronic sinusitis as unfitting and rated 10%.  The CI appealed to the Formal PEB, which affirmed the IPEB rating.

CI CONTENTION:  “The medical evaluation that was done on me by the U.S. Army was not rated fairly and equally to what the Department of Veterans Affairs used to rate my medical conditions when I was going through the MEB procedures while I was being medically separated from the U.S. Army.  The disability rating that I was awarded should of matched what the VA came up with in their findings/conclusions.  Therefore I should have been medically retired after serving in the U.S. Army almost 9 years.”

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 ratings for the unfitting KS are addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Military Records.

RATING COMPARISON:  

Service FPEB – Dated 20050119	VA - (19 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Kartagener’s Syndrome w/Chronic Sinusitis	6510	10%	Kartagener’s Syndrome w/Chronic Sinusitis	6699-6602	30%	STR	
No Additional MEB/PEB Entries	Other x 13	STR 	
Combined: 10%	Combined:  40%	

ANALYSIS SUMMARY: 

Kartagener’s Syndrome Condition.  The narrative summary notes that the CI had a diagnosis for KS.  While deployed he experienced multiple “upper respiratory infections” requiring medical treatment.  He would improve with treatment but deteriorate after completing his course of treatment with antibiotics and/or breathing medications.  In August 2003 he developed severe respiratory distress, not helped by the usual treatments, and he was evacuated to the Combat Support Hospital, admitted for pneumonia, and then transferred back to the US.  After his return, the CI continued with dyspnea on exertion, frequent productive cough, and chronic sinusitis with acute episodes of both sinusitis and bronchitis.  An allergy evaluation ruled out asthma and attributed all symptoms to KS with year round rhinitis, sinusitis and pulmonary symptoms from bronchiectasis and secretions that, due to the impaired cilia motion, collected in the lungs.  Chest X-ray on 22 January 2004 showed the situs inversus with no other abnormalities.  CT scan of the sinuses on 29 September 2004 showed evidence of acute and chronic sinusitis.  Pulmonary function tests (PFTs) 30 August 2004 were normal without evidence of asthma or other obstructive or restrictive lung disease.  At the MEB exam, the CI reported frequent, intermittent episodes of shortness of breath.  On the DD Form 2807, the CI noted coughing up blood in Iraq; difficulty breathing that got progressively worse and continued; lung congestion; right sided chest pain; and ear, nose and throat problems.  The CI listed current pertinent medications as Advair, albuterol inhaler, mometasone, guafenisin, and Entex.  The MEB physical exam referred to the DD Form 2808, which indicated an abnormal lung exam with no detail, and checked normal next to ears, mouth, throat and sinus.  The MEB examiner summarized that the CI’s symptoms had improved since his return, but not resolved and that he had been on antibiotics twice in the last 2 months and at least 12 times in the past 12 months.  At the VA Compensation and Pension (C&P) exam 24 October 2006, approximately, 19 months after separation, the CI reported constant sinusitis associated with headaches, purulent nasal, and hoarseness that was not incapacitating.  The sinusitis was treated with antibiotics.  He also reported always being short of breath and using an inhaler one to two times per day.  Lungs were clear without any abnormal sounds noted.  Sinus X-rays, reviewed from 16 October 2006, showed maxillary sinus.  Service treatment records (STR) indicated that the CI was seen and treated for symptoms due to KS continuously from mid-August 2003 with hospitalization for a week due to pneumonia; followed by outpatient treatment for a month with antibiotics and breathing medications; medications were stopped 20 October 2003.  The CI reported dyspnea on exertion 22 October 2003.  Records document treatment for 3 weeks with antibiotics from January to February 2004 for sinusitis and purulent sputum.  In May 2004 he was seen for shortness of breath and wheezing despite daily inhalers and treated with Albuterol nebulizer.  During the 4 months from October 2004 to February 2005, the CI was treated three times with antibiotics (including an emergency room visit for difficulty breathing) for sinusitis, bronchitis and/or otitis media.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the KS with chronic sinusitis as 6510 (chronic sinusitis) at 10%.  The VA rated the KS condition 23 November 2005 as 6699-6602 (analogous to asthma) at 30% based on STRs and use of inhalers.  The Board deliberated the appropriate rating of the KS condition and considered that sinusitis and bronchiectasis were both separately ratable components.  The Board was able to achieve no higher than a 10% rating for each component separately.  The Board opined that coding the KS condition as either sinusitis or bronchiectasis episodes alone would understate the CI’s systemic condition; at the majority of evaluations he was experiencing both sinus and lung symptoms, but at times one or the other was predominate.  The Board considered that the sinus and lung dysfunction each contributed to the co-mingled disability of the KS condition and agreed that a combined rating approach better represented the CI’s functional impairment due to KS.  Of the seven medical treatments with antibiotics in the record in evidence from 2002 until separation, five involved treatment for the sinus and lung condition; one was for the lung alone; and one where treatment was begun for the sinus condition and changed the next day to include both.  The evidence in the record supports that the CI required antibiotic treatments that lasted for weeks, more than six times per year in the year leading up to the MEB exam, as well as daily treatment with inhaled bronchodilators and steroids for bronchiectasis.  The Board adjudged that the CI’s KS condition most nearly met the 30% disability rating IAW §4.97, coded as 6601-6510 (analogous to chronic sinusitis w/bronchiectasis).  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 the KS 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 KS condition, the Board unanimously recommends a permanent disability rating of 30%, coded 6601-6510 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:

UNFITTING CONDITION	VASRD CODE	RATING	
Kartagener’s Syndrome with Chronic Sinusitis Condition	6601-6510	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121229, 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 AR20130011456 (PD201300029)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA