RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00780
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Water Treatment Specialist, medically separated for “pneumothorax, left spontaneous,” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20080407	VARD - 20150803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pneumothorax, Left Spontaneous	6843	0%	Restrictive Lung Disease Status Post Pleurodesis	6843	10%	20150717	
Depression	Not Unfitting	Depression	9434	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Pneumothorax, Left Spontaneous.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s first pneumothorax occurred on 25 February 2007.  The second pneumothorax occurred on 25 July 2007 and hospitalization included surgery of bleb resection and pleurodesis with pleural abrasion and medication.  The MEB forwarded “recurrent left pneumothorax” for PEB adjudication.  

The MEB NARSUM examination on 22 October 2007, 6 months prior to separation, noted complaints of chest pain with difficulty breathing.  He had decreased stamina with difficulty climbing stairs, walking greater than 100 meters, or any strenuous activity.  Analgesics and albuterol inhaler provided some relief.  X-rays showed no evidence of residuals of recurring pneumothorax.  Pulmonary function tests (PFTs) from 13 June 2007 showed “minimal obstructive lung defect” with “insignificant response to bronchodilators” with values of FEV-1 of 104% and FEV-1/FVC of 87 percent.  The thoracic surgeon summarized PFTs from June 2007 (unknown date) as normal “with no response to a bronchodilator ruling out asthma.”  Reported PFTs values were FEV-1/FVC of 73 percent and FEV-1 of 3.49L [73.5% using predicted value from the 13 July PFTs].  There were no PFTs in evidence following the July 2007 surgery.  Physical examination showed well healed scars on the left chest with no tenderness.  Lung were clear with normal respirations and normal exam.  There was no VA Compensation and Pension (C&P) evaluation performed proximate to separation (the first C&P in evidence was in 2015).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the pulmonary condition 0%, coded 6843 (traumatic chest wall defect, pneumothorax, hernia, etc.), citing normal PFTs and “VASRD paragraph 4.31, as he does not meet the criteria for a higher rating IAW the VASRD rating formula for Restrictive Lung Disease.”  The VA rated the pulmonary condition 10% coded 6843, based on the VA C&P examination 7 years after separation, citing “forced expiratory volume in one second (FEV-1) of 71 to 80 percent of predicted value (74%).”  The Board noted that although the thoracic surgeon characterized the PFTs as clinically normal, the source PFT values (FEV-1/FVC of 73 percent) met the 10% rating criteria of “FEV-1/FVC of 71 to 80 percent.”  Alternative rating analogous to atypical chest wall pain (5321 – Group XXI muscles) would have been no greater than 10% (moderate) and would rate no higher than the recommended 10% 6843 coding and rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the pulmonary condition, coded 6843.  

Contended PEB Conditions:  Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the pulmonary condition, the Board unanimously recommends a disability rating of 10%, coded 6843 IAW VASRD §4.97.  In the matter of the contended depressive disorder condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Pneumothorax, Left Spontaneous	6843	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, 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, AR20170000740 (PD201500780)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

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.   

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
(  ) DVA