RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01990
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140821
SEPARATION DATE:  20060918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, SRA/E-4 (2A656/Aircraft Electronic and Environmental Systems Journeyman), medically separated for spontaneous pneumothorax status post pleurodesis.  The spontaneous pneumothorax condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  Spontaneous pneumothorax was forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “spontaneous pneumothorax status post pleurodesis” as unfitting, rated 0%, referencing application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 spontaneous pneumothorax condition is addressed below; and, 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 IPEB – Dated 20060726	VA - (11.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spontaneous Pneumothorax s/p Pleurodesis	6843	0%	Residuals of Spontaneous Left Pneumothorax	6899-6843	0%	20070830	
Other x 0 (Not is Scope)	Other x 4	20070830
20070910	
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20071108 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VASRD standards, based on ratable severity at the time of separation.

Spontaneous Pneumothorax Condition.  The CI initially presented to the emergency room (ER) in June 2004 with report of left-sided sharp chest pain diagnosed as spontaneous pneumothorax.  He was admitted, treated and discharged several days later.  A few weeks later, he experienced recurrence of symptoms and again diagnosed with a pneumothorax.  The CI successfully underwent surgical procedure (pleurodesis) to prevent further occurrences.  His condition stabilized and he had no further symptoms, other than chest pain until September 2004.  Primary Care Clinic entry dated 14 September 2004 noted the CI presented with concern about a collapsed lung.  He reported he felt “winded” on exertion, was unable to tolerate exercise and had left-sided chest discomfort that was also present at times on the right side.  The physical examination was unremarkable.  The CI continued to report chest pain with absence of clinical or radiological findings.  A primary care provider letter dated 28 January 2005 indicated if the CI had continued exposure to his work with pressurized aircraft, his risk factor for recurrent pneumothorax would increase.  The recommendation was made to retrain him.  The narrative summary (NARSUM) noted the CI reportedly declined being retrained and stated he did not wish to risk pressurizing aircraft.  The CI continued to report daily chest pain with no objective clinical findings.  Cardiovascular surgery consult entry dated 8 December 2005, indicated the CI reported persistent shortness of breath (SOB) and left chest pain.  The physician noted the review of chest X-rays and CT scan demonstrated no evidence of a third pneumothorax or bullae; however, opined an MEB was appropriate given the CI’s lack of desire to remain in the Air Force.  On 4 May 2006, the MEB NARSUM recorded the CI had numerous visits to primary care with reports of chest pain and all the examinations and radiological studies had been negative.  The physician referenced the 8 December 2005 consultation with the cardiothoracic surgeon who determined there was no surgical treatment to pursue and the CI could return to duty.  The examiner noted the CI had continued to refuse pressurizing aircraft with fear of recurrence of his condition.  The CI had been prescribed non-steroidal anti-inflammatory medications on an as-needed basis.  Physical examination of the chest was normal with good air movement.  The examiner stated the CI had continued to report left-sided chest wall pain, SOB, and had continued to refuse to work with pressurized aircraft.  The physician concluded the CI was unable to perform all of his duties and did not wish to continue in the Air Force.  The MEB NARSUM update on 9 June 2006, noted the CI continued to report chest discomfort and continued to refuse to be in pressurized aircraft; however, continued to report to work daily.  At the VA Compensation and Pension exam in August 2007, 11 months after separation, the CI reported a history of two spontaneous pneumothorax occurrences and noted he was unable to use the left arm for a period of one day after the surgery.  The CI indicated he was having symptoms of peripheral neuropathy in the left arm that he contributed to the surgical procedure (pleurodesis in 2004).  He reported he had a constant “aching burning sensation in his chest,” at times had sudden onset of sharp pain, and noted there had been no change in his condition for the better or worse in the past 2 years.  He took no medication.  Physical examination recorded the presence of residual surgical scars that were non-painful and well healed.  Pulmonary review of symptoms was negative except for the report of pain.  The physical examination of the chest was normal.  The diagnosis of residuals of spontaneous pneumothorax was recorded.

The Board directs attention to its rating recommendation based on the above evidence.  The MEB forwarded the condition of spontaneous pneumothorax and the PEB adjudicated the condition as unfitting, compensable and ratable.  The CI concurred.  There were no other conditions referred to the PEB.  Both the PEB and the VA rated the condition at 0% under the 6843 code.  The VARD noted the service treatment records did not indicate that there had been any residual lung condition associated with the CI’s symptoms and the VA physical examination that included chest X-rays, found no lung abnormalities; however, noted the CI had not cooperated with pulmonary function testing in regards to effort, and therefore, the exam was not adequate for medical or legal purposes.

The Board deliberated whether a 10% rating level was supported by the evidence at hand; however, concluded there was no clinical evidence of impaired lung function.  The Board noted that although the CI reported episodes of SOB, the available treatment record recorded no visits to the ER for SOB, no use of inhalers or steroids, no evidence of a clinical indication for the use of inhalers or steroids and no evidence of residuals affecting lung function.  The pulmonary function test referenced by the VA was considered invalid and therefore could not be used in the evaluation of lung capacity and airflow.  The Board agreed that a 0% rating was supportable by radiological studies and clinical evidence and the Board unanimously agreed that the 10% rating criteria was not supported by the evidence at hand.  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 spontaneous pneumothorax 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 spontaneous pneumothorax condition 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 there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-01990.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings