RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01996
BRANCH OF SERVICE:  Army	 
DATE OF PLACEMENT ONTO TDRL:  20050728            DATE OF REMOVAL FROM TDRL:  20070307 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Armor Crewman, medically separated from the Temporary Disability Retired List (TDRL) for “persistent pulmonary coccidioidomycosis,” with a  disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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  PEB – 20070130	VARD1 - 20060302	
TDRL Placement – 20050728	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL2 Removal	
Pulmonary Coccidioidomycosis	6835	30%	0%	Pulmonary Coccidioidomycosis	6835	NSC	NSC	
Hypertension	Not Unfitting	Hypertension	7101	0%	0%	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
1. Most proximate to TDRL Placement    2. Rating derived from C&P examination dated 20050928, ~2 mos. post-TDRL placement

ANALYSIS SUMMARY:  

Pulmonary Coccidioidomycosis.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented that the CI developed left-sided chest pain with shortness of breath in January 2004 (2 years after entry) and was diagnosed with pulmonary coccidiomycosis, a fungal infection of the lungs.  Radiographic evaluations in January, February, March, July, September, and December 2004 and May 2005 failed to document significant improvement.  Pulmonary function testing in April 2004 and May 2005 were normal.  Despite continuous treatment with antifungal medication, the lung condition did not adequately respond to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “slow-to-respond pulmonary coccidiomycosis” for PEB adjudication.  

On the MEB DD Form 2697, Report of Medical Assessment, and DD Form 2807-1, Report of Medical History, both dated 15 December 2004 (7 months pre-TDRL placement), the CI reported difficulties breathing, joint pains, coughing up blood; and antifungal therapy.  On the MEB DD Form 2808, Report of Medical Examination (undated), the examiner documented a normal lung and chest examination.  The MEB NARSUM examination was performed on 5 May 2005 (2 months pre-TDRL placement).  The CI reported shortness of breath and easy fatigability with ordinary activities, and inability to perform the duties of his military specialty or physical training.  The examiner documented a normal skin, lung, and lymph node exam.  He further opined that there had been “modest” improvement in the radiographic evaluations of the chest since January 2004, with persistent left lower lobe infiltrates, and “no subjective functional improvement.”  Medications were refilled in May 2005 for an additional year of therapy.  

At the VA Compensation and Pension (C&P) examination dated 28 September 2005 (2 months post-TDRL placement), the CI reported taking medication for more than a year, and having chest tightness of the lower rib cage and shortness of breath on mild to moderate aches insertion and chronic cough.  He denied night sweats and fever.  The examiner documented diminished breath sounds in both lung fields and no lymphadenopathy.  He diagnosed “pulmonary coccidiomycosis on treatment” and documented that the CI did not report for his pulmonary function testing.  

At a visit with the pulmonologist (for TDRL reevaluation) on 10 October 2006 (5 months prior to separation), the CI reported continued significant bilateral “flank” pain and fatigue.  He reported coughing up sputum over 2 months, which had been improving.  He also reported recurrent fever every week with an 8-pound weight loss over the previous year.  The examiner documented a clear lung examination with no wheezing and no cough.  Chest radiograph (undated) was reported as “normal with no infiltrates or adenopathy.”  Antibody titers for coccidiomycosis (dated 10 October 2006) were reportedly negative (indicative of resolved infection).  Further radiographic imaging on 18 October 2006 documented “multiple pulmonary nodules,” with the two largest being in the left lower lobe.  The examiner diagnosed “resolution of active coccidiomycosis” and discontinued the medications.  The pulmonologist clarified further in a memorandum dated 24 January 2007 that the radiographic changes were “not consistent with active disease,” but indicative of “old (resolved) coccidiomycosis.”  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB initially adjudicated the persistent pulmonary coccidiomycosis as unfitting, and placed the CI on TDRL with a rating of 30%.  At TDRL reevaluation, the condition was considered resolved, and the CI was separated with a rating of 0% coded 6835 (coccidioidomycosis).  After initially denying service connection, a VA Rating Decision dated 14 April 2006 granted service-connection and rated 0% citing the “absence of significantly disabling residuals.”  

The VASRD §4.100 for rating mycolic lung diseases grants a rating of 50% for “chronic pulmonary mycosis requiring suppressive therapy with…minimal symptoms;” a 30% for chronic disease and minor symptoms (without therapy); and a 0% rating for “healed and inactive mycotic lesions, asymptomatic.”  At TDRL placement, the CI had persisting complaints of fatigue, cough, chest (lower rib cage) pain, fever’ and weight loss indicative of “minimal” or “occasional” symptoms and consistent with chronic disease.  There was also documentation of another planned year of continued medications during the TDRL period.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 50% for the lung condition at TDRL placement.  

At TDRL removal, the STR showed evidence of inactive disease, as confirmed at the TDRL reevaluation examination and by the pulmonologist.  There was no evidence of active infection (via blood testing and antibody titers).  There were no new radiographic lung lesions or evidence of active lymph node disease to suggest active or chronic disease.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of 0% for the lung condition at TDRL removal.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the hypertension was not unfitting.  The hypertension was profiled with the lung condition in June 2005.  It was not implicated in the commander’s statement.  The NARSUM examiner opined that the condition was “well controlled and uncomplicated.”  It was not judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that the hypertension 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 fitness determination for the contended hypertension and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the lung condition, the Board unanimously recommends a disability rating of 50% at the time of TDRL placement and a rating of 0% at the time of TDRL removal and permanent disability disposition, coded 6835 IAW VASRD §4.100.  In the matter of the contended hypertension, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Pulmonary Coccidioidomycosis	6835	50%	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140506, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160008533 (PD-2014-01996)

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
place the individual on the Temporary Disability Retired List (TDRL) at 50% disability
rather that 30% for the period 28 July 2005 to 6 March 2007 and then following this
period no recharacterization of the individual's separation or modification of the
permanent disability rating of 0%.

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 temporary disability effective the date of the
original medical separation for disability with severance pay.

b. Providing orders showing that the individual was separated with a permanent
combined rating of 0% effective the day following the TDRL period with no
recharacterization of the individual's separation.

c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will
provide 50% retired pay for the temporary disability retired period effective the date of
the individual's original medical separation and adjusting severance pay as necessary
to account for the additional TDRL time in service.

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