RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03912
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Military Police, medically separated for “post-thoracotomy pain syndrome for benign pulmonary tumor,” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 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:  

SERVICE PEB - 20020502	VARD - 20031201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Thoracotomy Pain Syndrome	5099-5003	10%	Post-Operative Residuals of Left Lung Thoracotomy for Atelectasis	6604	30%	20030731	
			Residual Scar, S/P Thoracotomy	7805	0%	20030731	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:    

Post-Thoracotomy Pain Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), starting in 2000, the CI had a history of vague transient chest symptoms with abnormal findings in the left lung on a chest X-ray.   History also revealed the CI had pneumonia in Bosnia in 1998 and worked with refugees in Cuba in 1995.   Because antibiotics did not completely resolve the process, he had a chest CT [computed tomography] in June 2000 that showed left hilar lymphadenopathy (swollen nodes in the mid-chest) and what was felt to be rounded atelectasis (collapsed lung) of the left upper lobe of the lung.  A PET [positron emission tomography] scan revealed a pleural (outer portion of the lung) based abnormality in the left chest, which measured 5.8 cm x 2.8 cm x 7 cm; and, the extensive left hilar and mediastinal (central portion of the chest) lymphadenopathy was essentially unchanged.  A needle biopsy was negative for malignancy, but it demonstrated only adjacent pleural tissue.  The CI had no fever, chills, weight loss, fatigue, cough, hemoptysis (coughing up blood), voice change, or shortness of breath.  His PPD (test for tuberculosis) was negative. Prior to an open biopsy his pulmonary function studies were FVC [forced vital capacity] 73% predicted, FEV1 [force expiratory volume in 1 second] 76% predicted, and DLCO [diffusion capacity of the lung for carbon monoxide] 69% predicted.  Surgery on 28 February 2001 consisted of a left thoracotomy, which showed evidence of rounded atelectasis of the upper lobe of the anterior segment with thickened pleura at the mediastinal pleural border.  A partial left decortication of the lung and biopsies were taken.  Post-operatively, the CI had a hemothorax (blood in the chest cavity) and returned to the OR where the bleeding site was identified and controlled. 

The MEB narrative summary (NARSUM) dated 16 January 2002 indicated that since the surgery he complained of persistent discomfort in his left anterior chest, right anterior chest and left upper quadrant, which made it difficult for him to wear his web belt and his gear, and he was unable to complete the physical fitness test in the standard fashion.  On examination his lungs were clear bilaterally and he had a well-healed left thoracotomy incision as well as chest tube incision sites along his left chest.  His chest X-ray remained stable with no new changes.  The diagnosis of a post-thoracotomy pain syndrome was made.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2002, 7 months prior to separation, the CI reported he was still having chest pains from the left side around to the back and all the way to the scapula area from the operation a year earlier.  The medical examiner noted tenderness upon palpation in the area along the left thoracotomy and a large left thoracotomy scar.  Chronic post-thoracotomy pain (for benign lung pathology) was recorded as the diagnosis.  

At the VA Compensation and Pension (C&P) examination dated 31 July 2003, performed 9 months after separation, the CI reported shortness of breath when climbing stairs and intermittently when walking.  On examination, the CI had a normal gait and upright posture.  His lungs were clear and there were left thoracotomy scars with keloid formation.  A chest X-ray dated 31 July 2003, revealed a 3.5 cm left apical (upper portion of the lung) density with surgical clips within the lesion and a prominent left hilum.  A chest CT and/or correlation with prior history and an old CT were recommended.  Pulmonary function studies on 15 September 2003, 11 months post-separation, revealed the FVC 74% of predicted, FEV1 62% predicted and the FEV1/FVC 69%.  The spirometry (pulmonary function studies) demonstrated a mild obstructive ventilatory defect with a reduced vital capacity.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5099-5003 for the post-thoracotomy pain syndrome.  The VA assigned a 30% rating using code 6604 (chronic obstructive pulmonary disease) for post- operative residuals of the left lung thoracotomy for atelectasis and a 0% rating using code 7805 for a residual scar, status post thoracotomy.  The Board sought a route to a higher rating and noted the CI had a portion of his lung removed thereby more accurately warranting use of a code related to the respiratory system IAW VASRD §4.97 rather than use of a pain code.  While the CI had a FEV1 of 76% predicted prior to the thoracotomy, no pulmonary function studies were available for review postoperatively until the VA studies 11 months post-separation, which demonstrated an FEV1 of 62% predicted.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 30% for the post-thoracotomy pain syndrome with a mild obstructive ventilatory defect condition.  

BOARD FINDINGS:  In the matter of the post-thoracotomy pain syndrome condition, the Board unanimously recommends a disability rating of 30%, coded 6604 IAW VASRD §4.97.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Post-Thoracotomy Pain Syndrome with a Mild Obstructive Ventilatory Defect 	6604	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140905, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 (PD201403912)

1.	Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re­ characterize the individual's separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual's original medical separation for disability with severance pay.

2.	I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

           a.	Providing a correction to the individual's separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

          b.	Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

           c.	Adjusting pay and allowances accordingly.   Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

          d.	Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.	I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
(  ) DoD PDBR 
( ) OVA