RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02007
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150507
SEPARATION DATE:  20080804

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aircraft Electrical & Environmental Systems Journeyman) medically separated for sarcoidosis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was placed on duty and mobility limitations and referred for a Medical Evaluation Board (MEB).  Sarcoidosis was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated sarcoidosis as unfitting, rated 0% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  He was not rated for his contended muscle and joint pain and patches of dry skin.  His 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 condition 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 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:

IPEB – Dated 20080620	VA* - (~6 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sarcoidosis	6846	0%	Sarcoidosis with Mediastinal and Hilar Lymphadenopathy	6846	0%	20090210	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20091008 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Sarcoidosis.  The CI’s condition of sarcoidosis was first diagnosed in September 2007, a year prior to separation.  Prior to receiving his diagnosis, the CI had several constitutional complaints involving the respiratory system.  In June 2007, he was treated for streptococcal pharyngitis.  His health briefly improved; however, on 20 August he developed fevers, sore throats and headaches.  Diagnostic tests were negative. Three days later, he was seen in the clinic for wheezing.  Chest radiographs revealed bilateral hilar lymphadenopathy (enlarged lymph nodes).  He underwent multiple CT scans that showed cervical lymphadenopathy, enlarged liver and spleen, and marked bilateral hilar lymphadenopathy of the lungs.  On 17 September, the CI underwent mediastinoscopy with bronchoscopy that yielded findings consistent with sarcoidosis (inflammatory disease can affect organs, lungs, or lymph glands).  The CI was referred to a pulmonologist and was diagnosed with sarcoidosis.  Pulmonary function tests performed on 3 October 2007 were normal.  Repeat tests in January 2008 were again normal.  Chest radiographs dated 22 January 2008 were normal, specifically; there was no evidence of the bilateral hilar adenopathy.  The CI continued with routine pulmonary follow-up which recorded that he was stable and doing well.  He was asymptomatic, his chest pain had resolved, he had no cough, no sputum production, or skin lesions.  The CI was evaluated by ophthalmology at the end of February 2008 and had a normal eye exam.  The MEB narrative summary (NARSUM) dated 6 March 2008 noted the CI was never prescribed steroids, and had only missed work during the diagnostic and postoperative period, otherwise had not missed any duty days due to his medical condition.  The CI denied significant limitations from his condition, but noted his chest pain had somewhat limited his exercise capacity; however, he felt fit for continued duty.  Review of systems was positive only for chest pain.  Physical examination documented healed surgical scar (from the diagnostic procedure noted above) in the mid upper chest that was non-tender, and no other clinically significant findings.  The physician opined that although the CI had been essentially asymptomatic and never required steroid treatment for his sarcoidosis, the nature of the illness is chronic and may require lifelong physical fitness restrictions due to the chest pain.  His prognosis was assessed to be fairly good.  The examiner documented that the CI should not deploy or PCS to locations where specialty care is not available.  Addendum to the NARSUM dated 17 April 2008 noted there had been no change in the CI’s condition, and that “he is still fit for his primary and PRP duties.”  On 30 May 2008 the CI was seen in the medical clinic due to his concerns about multiple symptoms.  He had noticed fatigue over the past month, despite adequate hours of sleep.  He also reported an episode of lightheadness and blurred vision, and periods of shortness of breath with climbing stairs.  The examiner noted enlarged left submandibular lymph nodes; however, no other palpable nodes were present in the axillar, inguinal, or cervical areas, without any other clinical finding.  At the VA Compensation and Pension (C&P) examination, 6 months after separation, the CI noted he took no medication for his sarcoidosis, and that every couple of months he felt chest pressure that was relieved by a non-steroidal medication.  He also complained of shortness of breath, but did not observe wheezing.  His physical examination was normal. The commander’s performance statement noted the CI’s condition had not affected his ability to satisfy his duty requirements and opined that his condition would not prevent him from performing future assignments; however, the CI could not deploy, due to the restrictions of his profile.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the condition 0% using code 6846 (sarcoidosis).  A compensable rating under this code requires the presence of persistent symptoms requiring chronic low dose or intermittent use of corticosteroids, or the presence of an active disease or residuals as chronic bronchitis and extra-pulmonary involvement under specific body system involved.  The Board noted the condition was not compensable under the 6846 code; however, the Board reviewed the record for evidence that would support a rating under other potentially applicable codes.  In May 2008 the CI reported fatigue lasting 3-4 weeks, accompanied by lightheadedness, shortness of breath while climbing stairs, and visual changes, most of which appeared to have resolved by 3 June 2008.  At the 3 June 2008 clinic visit, the CI noted he had continued to have concerns with decreased energy, and had experienced some chest pain; however, he noted his chest pain had improved and his fatigue had no impact on his duties.  The Board also noted at the C&P, the CI reported chest pressure every 2 months that responded to non-steroidal medication.  Board members considered codes 6600 (chronic bronchitis) and 6354 (chronic fatigue syndrome); however, the condition was not ratable under either code.  A 10% disability rating under code 6354 requires periods of incapacitation of at least 1 but less than 2 weeks total duration or symptoms controlled by continuous medication; not supported by the evidence.  A 10% rating under the 6600 code requires the demonstration of abnormal pulmonary function tests; both PFTs in evidence prior to separation were normal.  The Board found no pathway to a compensable rating.  The Board acknowledged the VA’s determination, 3 years after separation that the primary sarcoidosis condition had evolved to include extra-pulmonary involvement which resulted in a 20% rating under the analogous coding of 6848-5025 (fibromyalgia).  The rating was based on clinical records that documented in October 2011 the CI reported pain and inflammation, and the VA respiratory examination in June 2012 that documented continued complaints of fatigue and intermittent chest pain.  However, at the time of separation there was insufficient evidence to support a rating under the fibromyalgia code since the record reflected the absence of muscle or joint pain.  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 for the sarcoidosis 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.  In the matter of the Sarcoidosis 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 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 20140301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02007.

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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR