RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00295
BRANCH OF SERVICE:  Army	Separation Date:  20041009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Administrative Specialist) medically separated for a vocal cord condition.  This condition could not be adequately rehabilitated 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).  Vocal cord dysfunction (VCD) was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (chronic rhinitis) for PEB adjudication.  The Informal PEB adjudicated VCD as unfitting, rated 0%.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI makes no specific contention in her application.  Her complete submission is at Exhibit A.   

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 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 VA, 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:  

IPEB – Dated 20040816	VA* - (~2 Wks Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
VCD	6699-6602	0%	VCD	6599-6516	0%	20040923	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 12 	
RATING:  0%	COMBINED RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20041203 (most proximate to date of separation (DOS)).   

ANALYSIS SUMMARY: 

Vocal Cord Dysfunction Condition.  The CI underwent extensive cardiopulmonary testing for shortness of breath and dyspnea on exertion.  The CI first developed shortness of breath in 2001 and was diagnosed with asthma.  In 2002 the CI was diagnosed with allergic rhinitis.  The CI underwent pulmonary function testing and exercise challenge testing in March 2002 which demonstrated shortness of breath without wheezing and interpreted as borderline normal.  She was treated with albuterol, allergy medications and oral steroids. The CI continued to report shortness of breath with exercise.  The Pulmonary addendum to the MEB performed approximately 19 months prior to separation, documented continued reports of shortness of breath without relief with asthma inhalational treatment.  The examiner listed diagnoses of VCD and chronic rhinitis.  An internal medicine treatment note dated 26 November 2003 documented good response to oral steroids and that the CI was not using the inhaler.  A speed pathology consultation dated 16 April 2004 noted a history of vocal cord like symptoms including chest tightness, inconsistent voice problems and a night time cough with spasm in the larynx.  The speech therapist opined that there was clinical evidence of VCD.  VCD therapy was initiated.  A speech therapy note dated 16 June 2004 listed a diagnosis of VCD with asthma.  The MEB Narrative Summary (NARSUM) examination performed approximately 4 months prior to separation noted a diagnosis of VCD. The physical examination was normal.  The VA Compensation and Pension (C&P) examination performed 17 days prior to separation documented reports of fair health and an inability to exercise due to overall weakness from VCD and asthma. The documented medications were Advair, Albuterol, Flonase and Allegra.  The pulmonary and oropharyngeal examinations were normal.  The examiner noted that she spoke extremely softly.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the VCD condition as 6699-6602 (analogous to asthma, bronchial), rated 0%.  The VA rated the VCD condition 0%, coded 6599-6516 (Laryngitis, chronic). The Board considered whether the evidence supported a higher than 0% rating.  There was documentation by both the pulmonologist and speech pathologist that the CI had shortness of breath with exertion, changes in her voice, and spasm of the larynx consistent with vocal cord dysfunction.  The Board agreed that the anatomical location and functional dysfunction most closely approximated chronic laryngitis.  Board members agreed that the evidence supported a 10% rating under VASRD code 6516 (hoarseness with inflammation of cords or mucous membrane).    After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a rating of 10% for the VCD condition coded 6599-6516.  

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 condition, the Board unanimously recommends a disability rating of 10%, coded 6599-6516 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, effective as of the date of her prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
VCD	6599-6516	10%	
RATING	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140102 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXXXXX, AR20160000191 (PD201400295)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

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.   

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:

CF: 
(  ) DoD PDBR
(  ) DVA