RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00670
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Infantryman, medically separated for “vocal cord dysfunction,” with a disability rating of 0%.  

CI CONTENTION:  The CI requests that all conditions be considered.  His 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 - 20060609	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vocal Cord Dysfunction…	6699-6602	0%	No VA Examination in Evidence	
Iron Deficiency Anemia	Not Unfitting		
History of Psoriasis			
Childhood Asthma			
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Vocal Cord Dysfunction.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI began experiencing a litany of multi-system symptoms that included shortness of breath, wheezing, and chest pain.  His extensive medical work-up was normal excepting a scope of the voice box which revealed a severe degree of paradoxical motion of the CI’s vocal cords which ultimately resulted in a diagnosis of “vocal cord dysfunction” (VCD).  Despite extensive counseling and treatment under the auspice of Speech Pathology, the CI’s ‘air hunger’ type symptoms remained and the primary condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “vocal cord dysfunction” for PEB adjudication.  At the MEB NARSUM examination in February 2006, 5 months prior to separation, the CI’s chief complaint was “shortness of breath”.  A complete physical examination (PE) was unremarkable.  The provider noted that “…the [CI] was unable to maintain any degree of physical training or exercise due to persistent symptoms.”  There was no VA Compensation and Pension (C&P) examination contained in the case file and therefore, any impairment recommendation will be based upon the STR and MEB documents.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the VCD condition as 6699-6602 (analogous to bronchial asthma), rated 0%.  The Board considered whether the evidence supported a higher than 0% rating.  There was clear clinical documentation that the CI had shortness of breath with exertion and paradoxical movement of the vocal cords consistent with VCD.  The Board agreed that the anatomical location and local dysfunction most closely approximated the VASRD code of 6516 (chronic laryngitis).  Board members further agreed that absent clinical findings of voice hoarseness or inflammation about the cords or mucous membranes would not support a positive impairment rating in this case.  After due deliberation, and considering all 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’s adjudication for the VCD condition coded 6699-6602.  

Contended PEB Conditions:  Iron Deficiency Anemia (IDA), History Of Psoriasis, and Childhood Asthma.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  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 IDA, history of psoriasis, and childhood asthma 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 20150603, 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, AR20170002441 (PD201500670)

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