RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01019
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “pneumonia with pleural effusion, resolved, with residual malaise,” with a disability rating of 0%.

CI CONTENTION:  Illness contracted while in military service.  The 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 - 20070810	VARD - 20071119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pneumonia with Pleural Effusion	6899-6845	0%	Status Post Progressive Multilobar Pneumonia with Septic Shock, Pancytopenia and Pancreatitis	6899-6600	NSC	20070914	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Pneumonia with Pleural Effusion.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pneumonia condition was diagnosed in April 2007 after presenting for an upper respiratory infection.  The CI had severe, rapidly progressive pneumonia requiring intensive care unit hospitalization with intubation and chest tubes.  The CI had convalescent leave and prolonged rehabilitation without the ability to return to training.  The MEB forwarded “status post rapidly progressive multilobar pneumonia with septic shock, pancytopenia and pancreatitis” for PEB adjudication.  The MEB NARSUM examination on 9 July 2007, 5 months prior to separation, noted complaints of continued dyspnea with exertion, not having the same cardiovascular stamina that he had at enlistment, and a desire to separate from the Air Force.  Physical examination showed a normal lung and chest examination.  Pulmonary specialist evaluation on 19 July 2007 noted the CI complained of difficulty with stairs, citing weak legs.  He no longer had chest pain or shortness of breath.  He was able to jog but not run due to limitations of his legs.  The CI denied other respiratory complaints.  Physical examination showed normal lungs and cardiovascular findings.  Pulmonary function tests were normal including spirometry (FEV-1 of 94 percent predicted and FEV-1/FVC of 84 percent), normal diffusing capacity of the lungs for carbon monoxide (DLCO) (over 80 percent), and normal blood gas (ABG) testing.  The pulmonary specialist stated “(CI’s) pneumonia, while severe when active, has now resolved.  There is no radiographic abnormality on chest X-ray, routine labs have normalized.  He has no subjective respiratory complaints.  He does not have any significant objective findings of respiratory abnormalities, notably normal chest X-ray, spirometry and DLCO on pulmonary function tests.  He has a normal ABG.  It appears that he has already made a full pulmonary recovery and no long-term adverse pulmonary findings related to the pneumonia are anticipated.  No further pulmonary follow-up is necessary.”

At the 14 September 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported a history of pneumonia with a 1 month hospitalization.  He denied current respiratory symptoms or treatments.  Physical examination showed normal lung and chest wall findings.  The examiner stated that the CI had no current functional limitations.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the pneumonia with pleural effusion condition 0%, coded analogously to 6845 (chronic pleural effusion or fibrosis), citing resolved pneumonia with no significant diagnostic imaging, pulmonary function test, or laboratory findings; with residual weakness and malaise preventing return to duty.  The VA rated the status post progressive multilobar pneumonia with septic shock, pancytopenia and pancreatitis condition as not service connected coded 6899-6600 (bronchitis, chronic), based on the C&P examination 1 months after separation, citing no functional limitations and no evidence that a pulmonary condition existed on exam.  The CI had no pulmonary symptoms by the time of the pulmonary specialist’s evaluation or VA examination.  The FEV-1, FEV-1/FVC, and DLCO values were all normal and did not reach the levels required for a 10% rating under either code 6845 or 6600.  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 pneumonia with pleural effusion condition.

BOARD FINDINGS:  In the matter of the pneumonia with pleural effusion condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01019.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings