RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01540
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Avionics Systems Journeyman, medically separated for “dyspnea associated with paralyzed right vocal cord,” with a disability rating of 10%. 

CI CONTENTION:  “Review all conditions.”  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 - 20050328	VARD - 20051003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dyspnea Associated with Paralyzed Right Vocal Cord	8210-8299	10%	Moderate Restrictive and Moderate Obstructive Lung Disease	6699-6845	10%	20050815	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Dyspnea Associated with Paralyzed Right Vocal Cord.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), in October 2003, the CI was first evaluated in the allergy clinic for possible asthma.  He reported symptoms in childhood consistent with asthma although he had never been given the diagnosis formally.  Pulmonary function tests (PFTs) were consistent with an obstructive disease (such as asthma), but did not change with medications (such as broncho-dilators or steroids).  Clinically, he did not improve with medications either and these were ultimately discontinued.  A CT scan of the chest to evaluate for possible emphysema was negative for it or evidence of chronic obstructive disease (COPD).  He was referred to pulmonary medicine and found to have an exertional dyspnea (shortness of breath with exercise).  He had no duty limitations, but was not able to pass the USAF fitness test within the time allotted.  An examination by otolaryngology (not in evidence) showed paralysis of the right vocal cord.  The diagnosis of bronchopulmonary dysplasia (BPD), a complication of the lungs from the use of a ventilator early in life, was also considered as a diagnosis due to the premature birth of the CI.  The medical officer noted though that the CI did not have an abnormal chest CT, had good oxygenation and was not diagnosed with this condition by the pulmonologist.  On testing, multiple PFTs consistently showed both and FEV1 and FEV1/FVC ratio in the low to mid 70s.  This is consistent with obstructive disease (asthma, COPD, etc).  The forced vital capacity (FVC) was also typically in the low to mid 80s consistent with mild to moderate restrictive disease (seen with disease of the lung tissue and obesity).  The final pulmonary note in evidence was dated 21 October 2004, over 6 months prior to separation.  The CI had improved in his exercise time over the prior few months of an exercise program, but still did not meet USAF fitness testing standards.  His respiratory rate was normal, pulse oximetry (a measure of oxygenation of the blood) was normal at 98% saturated and his lungs were clear.  There were no signs of chronic pulmonary disease on examination.  The final diagnosis was dyspnea (shortness of breath) and paralysis of the right vocal cord.  He was seen in otolaryngology again on 1 February 2005 and the diagnosis of right true vocal cord paralysis confirmed on viewing with a flexible fiber optic scope.  

The MEB NARSUM examination was not dated.  It noted the above history and that the CI was on no medications.  It was also noted that the CI had not reported symptomatic dyspnea other than associated with the inability to pass the fitness test.  The physical examination was unremarkable without signs of acute or chronic pulmonary disease.  The panel noted that the CI was never noted to have difficulties with speech secondary to the vocal cord paralysis (it was well compensated).  The MEB forwarded “dyspnea” for PEB adjudication. 

At the 15 August 2005 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported that he was just able to pass fitness requirements when he first joined the military, but had progressive difficulty with time.  He reported occasional fatigue and dyspnea with exertion, but denied incapacitation.  His physical examination was normal as was a chest X-ray.  The PFTs showed an FEV1 of 73% and FEV1/FVC ratio of 70.7%.  These were interpreted as a combined moderate restrictive and obstructive defect.  There was not a response to a bronchodilator.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the dyspnea associated with paralyzed right vocal cord condition 10%, coded 8210 (moderate paralysis of 10th cranial nerve [vagus]) IAW VASRD §4.124a.  The VA rated moderate restrictive and moderate obstructive lung disease 10%, coded 6845 (chronic pleural fibrosis) IAW VASRD §4.100, based on the PFTs from the VA C&P examination 3 months after separation.  The panel considered the findings.  The treating pulmonologist attributed the dyspnea to the right vocal cord paralysis.  The PEB specifically attributed the dyspnea to the vocal cord paralysis and did not address a potential underlying lung disease.  A possible diagnosis of BPD was considered while the CI was under evaluation, but never made by the treating pulmonologist.  The chest X-ray, CT, and oximetry were normal making this diagnosis less likely.  However, bronchopulmonary dysplasia could account for the PFT changes and the VA examiner specifically noted that the CI had moderate restrictive and obstructive lung disease (this is a description of the PFT findings rather than a specific diagnosis).  Nonetheless, the cause of the abnormal PFTs was not specifically attributed to a specific condition.  Regardless, the unfitting component (functional impairment) was an inability to pass the fitness test and, consequently, and inability to deploy (to a potentially austere, physically demanding environment).  The assignment of multiple ratings for the same underlying impairment, dyspnea, is not permitted IAW VASRD §4.14 (avoidance of pyramiding).  Neither code employed provided a rating advantage over the other nor did the panel find another route to a higher rating.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the dyspnea associated with paralyzed right vocal cord condition.  

BOARD FINDINGS:  In the matter of the dyspnea associated with paralyzed right vocal cord condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20150619, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01540.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings