RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04219
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20051003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Fuels Specialist, medically separated for “congenital bullous lesion, status post partial resection with [two] subsequent pneumothorax” with a disability rating of 10%.

CI CONTENTION:  He has lifetime limitations and a spinal stimulator implant for permanent nerve damage.  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.

In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.

RATING COMPARISON:

SERVICE PEB - 20050810	VARD - 20060103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Congenital Bullous Lesion….[Left Lung]	6699-6603	10%	Bullous Lesion in Left Lung…	6844	10%	20051128	
Anxiety Disorder, NOS	Not Unfitting
Not PEB Adjudicated	Adjustment Disorder with Anxiety and Depression	9413	10%	20051210	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Congenital Bullous (Left Lung) Lesion.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first experienced respiratory symptoms of chest pain, shortness of breath, and coughing up blood in June 2004.  He was diagnosed with a large bullous (blister-like) lesion in the left lung.  On 18 June 2004, the CI received surgery to remove part of the lung lesion (small portion remained due to vascular adherence).  Postoperatively, the CI did well until mid-August 2004 when he experienced a spontaneous pneumothorax (collapsed lung) which required hospitalizations and the temporary placement of a chest tube.  He experienced a second collapsed lung on 24 September 2004.  Both hospitalizations were successful in re-expanding the CI’s lung.  Despite his intensive treatment and rehabilitation, the CI’s respiratory symptoms of shortness of breath upon exertion, non-productive cough, and painful breathing continued and further, non-surgical treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “congenital bullous lesion, symptomatic and resected with subsequent pneumothoraces post resection on two occasions” for PEB adjudication.

The MEB NARSUM Pulmonology examination performed on 23 June 2005 (3 months prior to separation) indicated that the CI’s oxygen saturation was normal at 99% on room air and his breathing was normal and non-labored.  Physical examination was normal with expected diminished left-sided breath sounds secondary to his surgical past.  Pulmonary function tests  conducted in December 2004 and again in June 2005 (9 and 3 months prior to separation) revealed parameters of FVC, FEV1, and FEV1/FVC all at or above 80%...indicating “normal” pulmonary function.  A repeat CT scan continued to reveal the residual remaining lesion in the left lung.

The original VA Rating Decision contained the Compensation and Pension examination’s key references that were performed on 28 November 2005 (2 months after separation).  The CI reported having dyspnea (shortness of breath) at rest that is worse with exertion and mild chest pain.  The physical examination showed normal anterior and posterior diameter with symmetry of the chest wall from the frontal view, with the exception of asymmetry of the left chest wall on frontal view.  The lungs were clear to auscultation (normal abnormal lung sounds).  Chest x-rays noted the previous thoracotomy on the left with at least one line of sutures as indicated with no active pulmonary process.  The pulmonary function test revealed an FEV1 of 88.0 %, FEV1/FVC of 94 %.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left lung condition 10%, analogously coded 6699-6603 (pulmonary emphysema) at 10%.  The VA also rated the left lung condition 10%, coded 6844 (post-surgical residuals (lobectomy) based on the C&P examination 2 months after separation, citing non-compensable pulmonary function testing; however, the CI experienced dyspnea with exertion, nonproductive cough, chest pain and discomfort.

The Board agreed, based on the CI’s residual symptoms and surgical intervention, that the VA’s coding choice of 6844 was most appropriate in this case.  Code 6844 rating criterion is predominantly based on pulmonary function testing.  The Board determined the pulmonary function testing found in evidence did not support the minimum 10% rating.  IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  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 left lung condition. 

Contended PEB Condition:  Anxiety Disorder Not Otherwise Specified (NOS).  The Board reviewed the case file records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the military Disability Evaluation System (DES).  The evidence of the available MEB record did contain the listed diagnosis of anxiety disorder NOS that was apparently dropped from the PEB’s adjudication during the DES process and therefore, the CI appeared to meet the inclusion criteria in the Terms of Reference of the MH Diagnosis Review Project.  The case file was reviewed by the Board in reaching the recommendation below.  The MEB forwarded anxiety disorder NOS to the PEB for adjudication.  The PEB did not adjudicate this MH condition.  Pursuant to the SRP as described above, this Panel will consider the MH diagnosis for fitness, and rating if applicable.

The listed anxiety disorder NOS condition was not psychiatrically profiled or implicated in the commander’s statement or judged to fail retention standards.  Overwhelmingly, the STR indicated that the occasional episodes of anxiety were closely tied to and or were due to “chronic worry” that the CI attributed to his other medical issues such as chronic pain, shortness of breath, and resulting panic as described at a VA C&P examination 2 months after separation.  There was no performance based evidence from the record that the anxiety disorder NOS significantly interfered with satisfactory duty performance near separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend the anxiety disorder as a separate unfitting condition and so no additional disability rating is recommended.

BOARD FINDINGS.  In the matter of the left lung condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the anxiety disorder NOS, the Board unanimously agrees that it was not unfitting for duty and therefore, cannot recommend it for an additional disability rating.  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 20141026, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04219.

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