RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03380
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20051021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Aviation Resource Management Craftsman, medically separated for “bilateral carotid body tumors” with a disability rating of 10%.

CI CONTENTION:  The PEB did not consider all of his ratable and compensable 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 - 20050823	VARD – 20060531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Carotid Body Tumors	8003-8099-7010	10%	Right Neck Residual Scar…	7802	10%	20060121	
			Right Neck Residual Scar…	7802	10%	20060121	
			Residual Paresthesia, Left Inferior Alveolar Nerve…Surgery	8205	10%	20060116	
			Baroreceptor Reflex Dysfunction	7011	10%	20060121	
Irritable Bowel Syndrome	Cat II	IBS	7319	10%	20060121	
Anemia, Stable	Cat III	Microcytic Anemia	7700	0%	20060121	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Bilateral Carotid Body Tumors.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral carotid body tumor condition was diagnosed in March 2004 after a 3-month history of persistent lymphadenopathy (swollen or enlarged lymph nodes).   The CI underwent excision of the right carotid body tumor (of neck) in May 2004 and the left in September 2004.  Post-operatively the CI developed symptoms of palpitations, tachycardia, and hypertension.  She was diagnosed with baroreflex syndrome which was well-controlled by medication.  An angiogram dated 1 December 2004 demonstrated 60% narrowing of the right carotid artery secondary to a mass.  CT scan (March 2005) and ultrasound (April 2005) evaluations of the neck demonstrated residual tumor in the right carotid artery.  Despite treatment, the bilateral carotid body tumor with surgical residuals condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB NARSUM examination dated 5 May 2005, 4 months prior to separation, showed a normal blood pressure, well-healed bilateral surgical scars, and full neck range of motion.  There was regular heart rate and rhythm.  There were no murmurs or carotid bruits.

At the VA Compensation and Pension (C&P) examination on 21 January 2006, performed 3 months after separation, the CI reported palpitations controlled by medication.  Physical examination, as referenced in a VA rating decision showed normal heart sounds without gallops.  The surgical scars were well-healed without tenderness disfigurement, ulceration, adherence, or instability.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the carotid body tumors 10% analogously coded 8099-8003-7010 (brain, new growth - supraventricular arrhythmia), citing status post excision with good cardiovascular control.  The VA rated residual paresthesia, left inferior alveolar nerve at 10% based on the VA C&P examination 3 months after separation, citing incomplete paralysis of the trigeminal nerve which is moderate.  The VA also rated left side of neck scar at 10% and right side of neck scar at 10% citing scars that are superficial and do not cause limited motion with an area.  The VA also rated heart palpations at 10% coded 7011 (ventricular arrhythmia [sustained]) citing heart palpitation requiring continuous treatment for control.

The Board agreed there was no evidence of four episodes of arrhythmia a year; workload of greater than 5 METs, but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray for a higher rating under the applicable codes (7010, 7011).  Although there was evidence of residual tumor, there was no documentation of new growth for a 60% rating analogous to 8003.  There was no evidence of associated unfitting scars for consideration of separate ratings.  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 bilateral carotid body tumor with surgical residuals condition.

Contended PEB Conditions:  Irritable Bowel Syndrome and Anemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the bilateral carotid body tumor with surgical residuals condition and IAW VASRD §4.124a and §4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended irritable bowel syndrome and anemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03380.

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,

Attachment:
Record of Proceedings