RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01534
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141216
SEPARATION DATE:  20040730

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Machinist's Mate) medically separated for restrictive lung disease.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  “Restrictive lung disease of unclear etiology” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB identified and forwarded five other conditions, “idiopathic small bowel enteritis; idiopathic gastroenteritis; possible chemical exposure; chronic intermittent abdominal pain and intermittent episodes of bright red blood per rectum” for PEB adjudication.  The PEB adjudicated “restrictive lung disease of unclear etiology,” rated 10%.  The remaining conditions were determined to be Category III conditions (conditions that are not separately unfitting and do not contribute to the unfitting conditions). The CI made no appeals and was medically separated.

CI CONTENTION:  “After separation, the first rating given by the VA which rendered the member unfit was 30%.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040611	VA – 6.6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Restrictive Lung Disease of Unclear Etiology	6604	10%	Restrictive Lung Disease 	6699-6602	30%	20050214	
Other x 5 (Not In Scope)	Other x 4	
Rating:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050604 (most proximate to date of separation [DOS]).  VA rated 30% from 20040731.
ANALYSIS SUMMARY:-

Restrictive Lung Disease Condition.  The CI was noted to have decreased lung capacity on pulmonary function testing (PFT) in October 2002, in a restrictive pattern (reduced total volume as reflected in the forced vital capacity measurement, FVC) without obstruction (such as seen in asthma as reflected in a reduced ratio between the forced expiratory volume in 1 second, FEV1 and the FVC; FEV1/FVC ratio).  At the time of a December 2002 examination, the CI reported feeling shortness of breath (SOB) when around chemical fumes.  At an internal medicine examination on 14 April 2003, the CI reported SOB with exertion for the preceding few years such as when carrying his children or running to second base while playing softball.  Evaluation with laboratory testing and computed axial scanning of the chest and lungs were negative for causes of restrictive lung disease including intrinsic lung disease (such as interstitial disease, inflammatory lung disease), lung scarring from prior injury, thickening of the lung lining (pleura), or chest wall disorder.  Neuromuscular disease (which can also cause a restrictive pattern from muscle weakness) was also excluded by electromyography.  A pulmonary specialist evaluation on 19 May 2003 noted onset of symptoms following inhalation of fumes while working on a submarine.  Since that time the CI reported experiencing cough and SOB when working with oils and corrosive cleaners and SOB when carrying his 18-pound daughter.  The pulmonary specialist recorded a history of smoking one pack of cigarettes per day for 14 years.  The pulmonary specialist noted a restrictive pattern on pulmonary function with a reduced diffusing capacity.  His initial diagnosis was chronic obstructive pulmonary disease/nicotine abuse.  He advised the CI stop smoking.  On follow up with the pulmonary specialist on 19 June 2003, the CI reported he had stopped smoking and was using an Advair inhaler twice per day and was breathing much better.  However by the 8 July 2003 internal medicine appointment the CI reported there was no change in his SOB symptoms.  A 20 November 2003 internal medicine appointment noted the CI continued to smoke and stated the restrictive lung pattern was likely secondary to being overweight (the CI’s body mass index was approximately 30).  An echocardiogram on 11 December 2003 demonstrated a normal right ventricular systolic pressure indicating absence of pulmonary hypertension that can result from interstitial lung disease or severe chronic obstructive pulmonary disease.  On follow-up with internal medicine on 29 December 2003, the CI complained of SOB with minimal effort.  The 2 February 2004 MEB narrative summary (NARSUM) recorded CI report of SOB with one to two flights of stairs and when exposed to noxious fumes.  Pulmonary function tests showed an FEV1 of 77% predicted with an FEV1/FVC ratio of 96%.  The MEB NARUM noted there was no specific diagnosis for the CI’s restrictive lung disease.  PFT on 19 May 2004 (prior to the IPEB), demonstrated an FEV1 of 77% predicted and an FEV1/FVC ratio of 83%.  The diffusing capacity was 49.3, approximately 100% of predicted.  PFT on 20 December 2004, 5 months after separation, demonstrated an FEV1 of 75%, and FEV1/FVC ratio of 76% and a diffusing capacity of 38.8 (117% predicted).  The test was interpreted as showing mild restriction with normal diffusion.  There was no improvement with bronchodilator.  At the VA Compensation and Pension examination on 14 February 2005, approximately 6 months after separation, the CI reported SOB with activity.  The examiner noted the CI was using an Advair inhaler.  On examination the lungs were clear.  PFT performed on 14 February 2005 reported an FEV1 of 74%, a FEV1/FVC ratio of 86% and a diffusing capacity of 70% predicted.  A repeat computed axial scan of the chest and lungs in June 2007 (3 years after separation) was normal.  PFTs in January 2010 were unchanged (FEV1 88%, FEV1/FVC ratio 88%, diffusing capacity 78% predicted).  A 16 February 2010 pulmonary evaluation noted that “In the distant past he used Advair but never felt that it improved his symptoms.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the restrictive lung disease of unclear etiology 10%, coded 6604 (analogous to chronic obstructive disease).  The VA rated the restrictive lung disease 30%, coded 6699-6602 (analogous to asthma), citing daily inhalational therapy.  The Board considered rating the restrictive lung disease analogously using the diagnostic code 6602 (asthma).  Regarding use of the asthma code, the VASRD states: “Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.”  However there was no diagnosis of asthma and no verified asthmatic attacks.  Therefore the Board concluded that the analogous use of the asthma code was not appropriate.  The Board also noted there was no benefit from use of Advair with persistent symptoms and confirmed by CI’s report following separation.  The CI was diagnosed with restrictive lung disease of unclear etiology and the pulmonary specialist also noted possible chronic obstructive lung disease associated with smoking.  The VASRD General Rating Formula for Restrictive Lung Disease (codes 6840-6845) and the rating criteria under diagnostic code 6604 (chronic obstructive pulmonary disease) are the same.  Therefore the PEB’s analogous use of the 6604 code was appropriate.  Under both the 6604 code and the General Rating Formula for Restrictive Lung Disease, a 10% rating is warranted when the FEV1 is 71% to 80% predicted, the FEV1/FVC ratio is 71% to 80%, or the diffusing capacity is 66% to 80% predicted.  The CI’s PFTs proximate to separation support a 10% rating (FEV1 75% and 77%, FEV1/FVC ratio 76% and 83%).  The CI’s PFT did not support the next higher rating of 30% (which requires FEV1 is 56% to 70% predicted, the FEV1/FVC ratio is 56% to 70%, or the diffusing capacity is 56% to 65% predicted).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the restrictive lung disease of unclear etiology 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 restrictive lung disease of unclear etiology condition and IAW VASRD §4.96, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 13 May 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN