RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02556
BRANCH OF SERVICE:  Army	BOARD DATE:  20150728
SEPARATION DATE:  20080904

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Specialist) medically separated for vocal cord dysfunction (VCD).  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  The CI’s profile did allow her to take an alternate aerobic event to satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “vocal cord dysfunction with possible underlying asthma component” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (gastroesophageal reflux disease [GERD]) for PEB adjudication.  The Informal PEB adjudicated her vocal cord dysfunction as unfitting and rated it at 10%.  The remaining condition (GERD) was determined to be not unfitting.  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 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 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:

IPEB – Dated 20080528	VA* - (~1 Month Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Vocal Cord Dysfunction…	6599-6520	10%	Dysphonia…	6599-6516	0%	20081017	
Gastroesophageal Reflux Disease	Not Unfitting	Gastroesophageal Reflux Disease	7399-7346	10%	20081017	
Other x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20081114 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Vocal Cord Dysfunction Condition.  The CI first developed symptoms of intermittent coughing, wheezing and shortness of breath in 2003.  A diagnosis of VCD was subsequently rendered in 2005, and was partially responsive to speech therapy and medication for GERD.  Pulmonary function testing on 24 September 2007 reported an FEV-1 of 110% of predicted.  The narrative summary (NARSUM) evaluation (4 months prior to separation) noted that symptoms were triggered by dust and exercise (especially after running), lasted up to an hour and occurred 3-4 times per week.  There was no report of symptoms between episodes.

At the VA exam a month after separation the CI reported that she was diagnosed with dysphonia (impairment of the ability to produce voice sounds) which was due to GERD.  Symptoms were difficulty breathing and hoarseness; duration and frequency were not described.  Examination noted normal speech without voice hoarseness.  There was no vocal cord or mucous membrane inflammation.   Pulmonary function testing showed an FEV-1 of 88% of predicted.  A second VA examiner noted that speech was “spontaneous, coherent, clear and well-modulated.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded analogously to 6520 code (stenosis of larynx).  The next higher 30% rating required an FEV-1 of 56 to 70% predicted, which was not in evidence.  A rating higher than 10% was therefore not justified via this pathway.  The Board also agreed that the VA’s 0% rating under an analogous laryngitis code (6516) was appropriate, based on the absence of 10% criteria (hoarseness, with inflammation of cords or mucous membranes).  Finally, because aphonia (inability to produce voice) was not present, a rating under 6519 (aphonia, complete organic) was not applicable.  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 VCD condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that GERD was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

The CI began treatment with medication for GERD after a normal upper endoscopy in December 2006.  While not reflected in the NARSUM, a pulmonologist in July 2007 acknowledged that GERD could be contributing to the VCD.  This likely explains why GERD was listed on the permanent profile (in addition to VCD) and forwarded by the MEB as failing retentions standards.  The VA examiner opined that the VCD was due to GERD in this case, although other symptoms attributable to GERD such as heartburn, epigastric pain and regurgitation were also reported.  The MEB examiner noted that the CI’s indigestion, heartburn and stomach trouble were “controlled with Prilosec” (antacid medication).  The commander’s statement referred to “breathing problems” as the impediment to the CI’s ability to perform duties.

This condition was reviewed and considered by the Board.  Although GERD may have contributed to the primary unfitting VCD condition, any such contribution was properly subsumed under the VCD rating.  There was however no performance based evidence from the record in this case that any other manifestations of GERD 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 this contended condition and so no additional disability rating is recommended.

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 VCD condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended GERD condition, 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.

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 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

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  XXXXXXXXXX, AR20160003282  (PD201402556)

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 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: