RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02462
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  19990416	
DATE REMOVED FROM TDRL:  20040202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Calvary Scout, medically separated from the Temporary Disability Retired List (TDRL) for “chronic fatigue, status post chemotherapy and autologous peripheral stem cell rescue with no evidence of recurrence,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions”.  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 based upon a 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 – 19990225/20031218	VARD - 20040604	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Chronic Fatigue, Status Post Chemotherapy and Autologous Peripheral Stem Cell Rescue with no Evidence of Recurrence	7799-7715
6399-6354	100%	10%	Mediastinal Germ Cell Tumor	7715-7700	100%	0%	
				Restrictive Airway Disease Associated with Mediastinal Germ Cell Tumor	6604	10%	10%	
COMBINED RATING:  100% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Fatigue, Status Post Chemotherapy and Autologous Peripheral Stem Cell Rescue with no Evidence of Recurrence.  The narrative summary (NARSUM) noted a diagnosis of a mixed germ cell tumor of the mediastinum (chest) with compression of the right lung in April 1998.  Surgical resection was performed in May 1998 followed by chemotherapy and a single bone marrow transplant in September 1998.  The CI declined the previously planned second bone marrow transplant and the condition was considered to be incompatible with deployable service obligations.  The MEB forwarded “mediastinal germ cell tumor” for PEB adjudication.  The PEB determined the CI’s condition unstable, ratable at 100% (total disability) and subsequently placed the CI on the TDRL effective 16 April 1999.

At the first TDRL reevaluation dated 6 March 2000, the CI reported no recurrence of the cancer.  He reported shortness of breath causing difficulty with physical exertion and that working 4 hours resulted in “such profound fatigue” that he needed a 4 hour nap to recover.  There was no laboratory evidence of anemia, hypothyroidism, or diabetes and no evidence of cancer recurrence.  The examiner recommended TDRL retention.  

At a TDRL reevaluation dated 14 November 2003 (3 months pre-separation), the CI reported chronic fatigue, but denied cough, and shortness of breath at rest or on exertion.  Physical examination showed a normal heart and lung examination.  Laboratory investigations showed no evidence of anemia, hypothyroidism, or diabetes and no evidence of cancer recurrence.  Radiographic evaluation documented a normal heart, lungs and mediastinum (chest).  

At the VA Compensation and Pension (C&P) examination dated 2 February 2004 (1 month post-separation), the CI reported becoming easily fatigued, with shortness of breath after running one block or climbing a flight of stairs.  The examiner documented a normal lung examination with normal respiratory rate.  Radiographic evaluation was similar to previous examinations.  Pulmonary function testing was not in evidence, however the results were documented on the VA rating decision dated 4 June 2004.  A diagnosis of “moderate restrictive airway disease” had been made secondary to a forced expiratory volume in 1 second (FEV-1) of 73%.  

The Board directs attention to the rating recommendation based on the above evidence.  The PEB initially placed the CI on TDRL and rated the “mediastinal germ cell tumor, status post thoracotomy, high dose chemotherapy” at 100% analogously coded 7799-7715 (non-Hodgkin’s lymphoma) and cited that the condition was not sufficiently stable for final adjudication.  The VA also rated 100% for the “mediastinal germ cell tumor” during the TDRL period, analogously coded 7715- 7700 (non-Hodgkin’s lymphoma; anemia).  The Board recognizes the PEB’s rating at TDRL placement as being a total disability of 100%.  

The PEB adjudicated the “chronic fatigue status post chemotherapy… with no evidence of recurrence” as unfitting, rated at 10%, citing “mild” symptoms.  It was analogously coded 7799-7715 (non-Hodgkin’s lymphoma) and 6399-6354 (chronic fatigue syndrome).  

The VA rated 0% for the “mediastinal germ cell tumor” at TDRL removal citing no evidence of metastasis, with the cancer in remission.  The VA granted service connection for “restrictive airway disease associated with mediastinal germ cell tumor,” and rated 10% based on pulmonary function testing that documented an FEV-1 of 73%.  

The Board considered the evidence for a higher than 10% rating at TDRL removal.  There was no evidence of cancer recurrence for a higher rating.  There was no documentation of “debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or other signs or symptoms that were nearly constant, restricting routine daily activities by less than 25% of the pre-illness level.”  There was also no documentation of symptoms that waxed and waned and resulted in periods of incapacitation of at least 2 but less than 4 weeks total duration per year in support of a higher rating.  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 “chronic fatigue status post chemotherapy… with no evidence of recurrence” condition.

BOARD FINDINGS:  In the matter of the “chronic fatigue status post chemotherapy…[and cancer] with no evidence of recurrence” condition and IAW VASRD §4.117, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0940 (PD201402462)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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 and hereby deny the individual's application.

This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA