RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01246
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “status post total thyroidectomy and I131 treatment of thyroid carcinoma” with a disability rating of 10%.

CI CONTENTION:  “Hypothyroidism, low back pain, generalized anxiety disorder, depression, GERD.”  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 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 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 - 20031022	VARD - 20040430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Total Thyroidectomy and I131 Treatment of Thyroid Carcinoma	7914-7903	10%	Status-Post Follicular Cancer with Thyroidectomy	7914-7903	60%	20040316	
			Scar, Status-Post Thyroidectomy Associated with Status-Post Follicular Cancer with Thyroidectomy	7914-7804	0%	20040316	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Status Post Total Thyroidectomy and I131 Treatment of Thyroid Carcinoma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was noted to have goiter, an enlarged thyroid, on his accession examination on 10 February 1999.  Thyroid function tests (TFTs) were normal and the CI was cleared for accession without further evaluation.  The examining physician noted that the goiter should not interfere with the wear of military uniforms.  During basic training, the CI noted that the goiter condition had progressed and pressed against his windpipe (trachea).  An evaluation revealed the presence of thyroid cancer.  This was treated with the removal of the left and then right thyroid lobes resulting in a total thyroidectomy.  The CI also went I131 ablation (treatment with a radioactive isotope of iodine).  He was subsequently begun on thyroid hormone replacement.  The CI was initially identified for an MEB in early 2001, but this was discontinued in early 2002 for stabilization of additional medical conditions.  At a February 2002 internal medicine appointment, the examiner documented an increase of 60 pounds from accession.  The examiner noted that the Synthroid dose had been decreased prior to the increase in weight and also a decrease in energy without a recent check of the TFTs.  Over the course of the next year, the CI completed evaluation of the other medical conditions which were not medically unacceptable.  He was also semi-stabilized on medications and then re-entered into the MEB process.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 29 May 2003, 7 months prior to separation, the CI was noted to weigh 250 pounds, a decrease of 12 pounds from a year earlier.  The MEB NARSUM examination was dated 26 August 2003, 4 months prior to separation.  The CI reported that he had normal energy in the morning, but had progressive fatigue throughout the day.  He was able to play golf in the morning on weekends.  He also reported a significant weight gain following the surgery.  However, the NARSUM examiner noted that there were no TFTs in evidence between August 2002 and May 2003 suggesting that care might have been suboptimal.  The examiner did not record a history of weakness, cold intolerance, constipation, or mental sluggishness.  On examination, his weight was 262 pounds.  Both blood pressure and pulse were normal.  There was no tremor; reflexes and strength were normal.  The Board noted that periodic surveillance testing after the initial treatment had been negative for recurrent cancer.  The MEB forwarded “total thyroidectomy for follicular cancer with replacement therapy that is unstable” for PEB adjudication.  

At the VA Compensation and Pension (C&P) evaluation performed on 16 March 2004, 3 months after separation, the CI reported that he had run out of medications three days prior.  He denied any specific symptoms, but noted that his dosage was being adjusted at the time of separation.  He reported mildly reduced energy.  He worked out every other day.  This included swimming for 45 minutes, weight training twice a week, and golf when able.  Again, the examiner did not record a history of weakness, cold intolerance, constipation, or mental sluggishness.  His weight was stable at 260 pounds.  The blood pressure and heart rate remained normal.  The neurological examination was normal; this also implies that there was no tremor.  Other than the surgical scar, the skin was normal.  Two days later, TFTs were abnormal showing a low level of thyroid hormone and a high level of thyroid stimulating hormone (TSH).  The medical officer observed that this would be expected as the CI had been off medications for several days prior to the tests being accomplished.  

The Board directed attention to its rating recommendation based on the above evidence.  The initial and reconsideration PEBs rated the thyroid condition 10%, dual coded 7914 (neoplasm of any part of the endocrine system) and 7903 (hypothyroidism).  It noted that the CI was on continuous medication for control.  The VA rated the thyroid condition 60% using the same coding options.  It cited the low energy and abnormal TFTs in the decision and noted that the CI did not meet the criteria for a 60% rating, but that these best fit the impairment in evidence.  

The Board considered the evidence and the coding options available.  The medical officer observed that the CI was hypothyroid as a result of surgery and I131 ablation.  The 7914 code supports a 100% rating for 6 months after treatment for the cancer.  The Board noted that there was no treatment for the thyroid cancer for over 3 years prior to separation and that testing had not shown recurrent disease.  Therefore, a higher rating at separation is not supported by this code.  The Board then considered the 7903 code.  It noted that the criteria for a higher 30% rating include fatigability, constipation and mental sluggishness.  The CI did endorse progressive fatigue on the NARSUM evaluation and mildly reduced energy at the VA examination.  Neither constipation nor mental sluggishness was recorded and objective signs of hypothyroidism were absent on both examinations.  The higher 60% rating criteria include weakness, mental disturbance, and weight gain.  Of these, only weight gain was present.  However, the CI exceeded weight standards at accession and was just under the body fat maximum.  Also, the record shows that the CI grew almost 2 inches after the accession examination.  The Board also noted that the CI was on limited duty for low back pain at separation.  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 thyroid condition.  

BOARD FINDINGS:  In the matter of the status post total thyroidectomy and I131 treatment of thyroid carcinoma” condition and IAW VASRD §4.120, 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011795, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,