RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02942
BRANCH OF SERVICE:  Army	BOARD DATE:  20150515
DATE OF PLACEMENT ONTO TDRL:  19980409 
DATE OF REMOVAL FROM TDRL:  20030408 

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 non-Hodgkin’s lymphoma (NHL).  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was referred for a Medical Evaluation Board (MEB).  “Likely malignant NHL,” “acute respiratory distress syndrome (ARDS),” and “probable bilateral pneumonia,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.   No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “aggressive high-grade malignant NHL with ARDS and probable bilateral pneumonia” as unfitting, rated 100% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was placed on Temporary Disability Retired List (TDRL).  Approximately 5 years later, the IPEB adjudicated Stage IV B NHL in remission as unfitting, rated 0% with application of the 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 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 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:  

Final PEB – 20030709	VA Rating Decision1 - 19980915	
TDRL Placement – 19980409	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Non-Hodgkin’s  Lymphoma	7715-6604	100%	0%	Non-Hodgkin’s  Lymphoma	7715	100%	0%	
Other x 0 (Not in Scope)	Other x 1	
RATING:  100% → 0%	RATING:  100%→ 0%	
1. Most proximate to TDRL Placement
2. Rating derived from C&P exam dated 19980819, ~4 mos. post-TDRL placement 
3. Rating derived from C&P exam dated 20120128, ~9 yrs. post-TDRL removal 

ANALYSIS SUMMARY:  The service treatment record (STR) contained very few original source documents in regards to the CI’s primary condition.  Much of the historical medical information was gathered from the required reports as part of the Disability Evaluation System (DES).  

Non-Hodgkin’s Lymphoma.  In 1998 the CI presented with a host of constitutional symptoms that were subsequently diagnosed as a high-grade malignant NHL.  Initially, her condition was extremely critical having respiratory complications which required ventilator assisted breathing.  Secondary to the extremis nature of her condition, an initial narrative summary, MEB, and PEB were conducted on 8 April 1998 and the CI was placed on the TDRL at 100% impairment according to the VASRD rating guidelines.  On 9 April 1998, the CI began chemotherapy for her condition and gradually was weaned off ventilator assistance.  Her overall symptoms improved after she received a bone marrow transplant in September 1998.  The first TDRL re-evaluation examination was performed on 20 January 1999 (9 months after TDRL placement) whereby the CI endorsed fatigue, generalized body aches, and a sore throat.   Her physical examination (PE) was unremarkable.  Her condition was “stable” and the examiner noted, “…by history, her NHL is in remission.”  Her diagnoses were noted as NHL, status post chemotherapy and bone marrow transplant.  The corresponding IPEB retained her on TDRL.  

The second TDRL re-evaluation examination was performed on 5 March 2000 (23 months after TDRL placement) whereby the CI endorsed fatigue and painful breathing.  Despite normal exam and laboratory findings, the examiner recommended to retain her on TDRL status citing literature studies of greater than 2-year survival rates.  The corresponding IPEB of 25 April 2000 concurred with the examiner’s recommendation.  

The third and final TDRL re-evaluation examination was performed on 30 December 2002 (7 months prior to TDRL removal) whereby the CI endorsed a few cold-like symptoms, but denied all other constitutional symptoms associated with lymphoma.  The PE, laboratory and radiographic work-ups were all normal.  The examiner noted that from a clinical perspective, the CI was in complete remission of her NHL condition and has been so for the last 4 years and 7 months.  The corresponding IPEB of 9 July 2003 permanently separated the CI at 0% impairment citing disease remission without residual effects.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the pre-TDRL original IPEB and VA examination cited active disease and or treatment for a rating of 100% under primary VASRD code of 7715 (NHL).  All Board members agreed that the appropriate and equivocal code for rating the NHL condition is 7715 and the VASRD §4.117 rating schedule is based upon a single rating of 100% “with active disease or during a treatment phase”…otherwise rate on residuals as applicable.  Having the maximum impairment level implemented near the time of TDRL placement, Board members then focused their attention on finding evidence for a §4.117 rating higher than the 0% permanent rating adjudicated by the PEB at TDRL termination.  Members extensively considered all exam findings nearest to TDRL removal and absent use of continued medications, abnormal laboratory analysis, recurrent infections, or other possible residual NHL complications; no positive impairment rating was applicable.  After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends no change in either the TDRL placement disability rating at 100% nor the permanent disability rating of 0% for the NHL 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 NHL condition, the Board unanimously recommends no change in the PEB’s adjudication of 100% impairment for the period of TDRL and a 0% permanent rating, coded 7715 IAW VASRD §4.117.  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 20140619, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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 XXXXXXXXXXXXXXXXXX, AR20150018867 (PD201402942)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA