RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01141
BRANCH OF SERVICE:  MARINE cORPS 	SEPARATION DATE:  20070115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Field Artillery Cannoneer, medically separated for “reduced effort tolerance as a result of status post pneumonia (coccidial mycosis)” and “residual right-sided fibro thorax as a related Category II diagnosis” with a 10% disability rating.  

CI CONTENTION:  Condition continues to negatively impact daily activities. The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20061108	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reduced Effort Tolerance as a Result of S/P Pneumonia (Coccidial Mycosis)	6899-6845	10%	No VA Exam in Evidence	
Residual Right-sided Fibro Thorax	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:   NA	

ANALYSIS SUMMARY:  

Reduced Effort Tolerance as a Result of status post (S/P) Pneumonia.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pulmonary condition began in 2005 after pneumonia when he was hospitalized and treated in the usual manner but required a chest tube.  He recovered clinically but did not regain effort tolerance.  Chest x-ray showed costophrenic angle blunting with trapping of the right lower lobe.  

The 30 August 2006 MEB NARSUM examination, 4 months prior to separation, noted the CI could perform activities of daily living  and his civilian work without restriction but could not participate in sports as previously and was unable to train with his troop to pass the run test.  Pulmonary function tests (PFTs) showed a restrictive ventilator defect with a forced volume capacity of 66% of predicted and FEV-1/volume capacity ratio (FVC) was normal.  Respiratory and skeletal muscle strength were normal.  Exercise stress test showed maximum power output was 37% of his predicted max, and peak oxygen consumption was markedly reduced at 35% of predicted.  Maximum power output was limited by shortness of breath (SOB) and fatigue of equal severity.  He was more breathless than he ought to have been for the low work output and his ventilation was excessive at all work loads, much of which was due to hyperventilation.  Physical examination showed a reduction in breath sounds at the right base but was otherwise normal.  The panel concluded the CI had limited effort tolerance due in part to restrictive lung disease secondary to pleural thickening that restricted his right lower lobe and in part complicated by exercise hyperventilation.  There was no VA Compensation and Pension evaluation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the reduced effort intolerance condition 10%, coded 6899-6845 (chronic pleural effusion or fibrosis), citing the above-stated conclusions.  The PEB also listed “residual right-sided fibro thorax” as a related diagnosis (Category II) contributing to the disability.  The PEB’s Category II diagnosis of residual right-sided fibro thorax is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.  

The panel noted the CI was rated under the 6845 code, for which the General Rating Formula for Restrictive Lung Disease applies.  The PFTs showed an FEV-1/FVC ratio that was normal, so there was no evidence to support a rating higher than 10%.  The panel also considered whether a rating under the 6835 code (coccidioidmycosis) would yield a higher rating but there was no documentation of bloody sputum or productive cough, which would warrant a 30% rating.  The panel concluded there was no evidence to support a rating higher than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the reduced effort intolerance condition.  

BOARD FINDINGS:  In the matter of the reduced effort tolerance condition and IAW VASRD §4.100, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN