RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01839
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “vocal cord dysfunction” with a disability rating of 10%.

CI CONTENTION:  The CI listed the following in her contention; “chronic cough, sometimes hard to breathe, nasal congestion / worse at night; headaches, no matter what type of medicine given it does not work, and periodic hoarseness.”  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 progression or complications of service-connected conditions after separation.  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 - 20050602	VARD - 20070509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vocal Cord Dysfunction	6520	10%	Vocal Cord Dysfunction	6599-6516	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Vocal Cord Dysfunction.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed a chronic intractable cough during a 2003 deployment to Kuwait and underwent a comprehensive evaluation after redeployment.  She was diagnosed with mild reversible small airways disease, allergic rhinitis, “minimal to minor” gastroesophageal reflux, and left phrenic nerve (e.g., left diaphragm) paralysis; but, by specialty opinions, none of these were believed to be likely etiologies of the cough.  An otolaryngology consultant documented normal vocal cords by endoscopic visualization; but, a pulmonary consultant visualized paradoxical vocal cord motion during a coughing episode, and opined that this was the likely etiology.  The diagnosis was “vocal cord dysfunction” that was considered to be psychogenic; although, a subsequent psychiatric consultant documented only a difficulty adjusting to the military and a desire to be discharged, opining that there was no psychiatric diagnosis.  Outpatient STR entries documented measurements of FEV-1 ranging from 72% to 88% predicted (bronchodilator responsive); and, did not identify voice or swallowing impairment or any other additional VASRD-ratable findings.  The 22 April 2005 NARSUM examination, 3 months prior to separation, documented a persistent and frequent cough that was “quite incapacitating ... [and] ... significantly increased with laughing, running, any heavy exercise, wearing a gas mask, and doing sit-ups and PT training.”  The NARSUM emphasized the cough as unfitting, rather than hoarseness or vocal cord dysfunction.  The physical examination was normal with “no evidence of any labored breathing.”  There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 6520 (larynx, stenosis of, including residuals of laryngeal trauma) cited the most recent FEV-1 measurement of 72% predicted.  The VASRD §4.97 criteria for a 10% rating under 6520 are “FEV-1 of 71- to 80-percent predicted, with flow-volume loop compatible with upper airway obstruction [emphasis added].”  The panel noted that the CI’s pulmonary function deficit was for small airways resistance, not upper airway obstruction; and, furthermore, there was no clear etiologic link of the pulmonary criterion with vocal cord dysfunction.  The VA‘s 0% rating, based on the same STR evidence, was under code 6599-6516 (analogous to chronic laryngitis) and cited failure to meet the minimum 10% criteria of 6516, i.e., “hoarseness, with inflammation of cords or mucous membrane.”  Other than the PEB and VA choices, none of the codes under §4.97 are applicable (even for analogous rating) given the absence of a specific pulmonary etiology or laryngeal pathology other than the paradoxical motion.  Hoarseness was not in evidence and cough is not a criterion of any code.  Considering these constraints, members agreed that there was no VASRD route to a rating higher than the PEB’s 10%.  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 of the vocal cord dysfunction.

BOARD FINDINGS:  In the matter of the vocal cord dysfunction and IAW VASRD §4.97, 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 20150622, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009171, XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure