RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01907
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20030331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty , E1, Marine Recruit, medically separated for “right lower lobe pneumatocele” with a disability rating of 10%.  

CI CONTENTION:  He has never fully recovered from this incident.  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 - 20030211	VARD - 20030930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lower Lobe Pneumatocele	6899-6845	10%	Scar, Residuals of Pulmonary Disease	6844-7804	10%	20030917	
Right Sided Pleurisy	Cat II					
Recent Right Pneumothorax	Cat II					
Bilateral Pneumonia, Resolved	Cat II					
Right Pleural Effusion VS Scar	Cat II					
RATING:  10%	RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Lower Lobe Pneumatocele.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lung condition began in July 2002 during basic training.  
The CI was hospitalized for 11 days and treated with a chest tube and antibiotics for a pneumonia.  During convalescence, scarring of the lung resulted in development of a lung cavity (pneumatocele) with subsequent effusion versus scar formation.  Despite therapy, symptoms of intermittent cough, and shortness of breath with brisk walking or increased exercise persisted.  

During the October 2002 MEB examination (recorded on DD Forms 2807 and 2808) 5 months prior to separation, the CI reported nonproductive cough, shortness of breath, and chest pain during breathing.  Physical examination showed decreased breath sounds on the right lower chest with no evidence of wheezing.  There was no tenderness on palpation, and no erythema or swelling of the associated scar.  The 5 November 2002 MEB NARSUM examination, 4 months prior to separation, noted similar complaints.  Physical examination showed symmetric chest expansion with no accessory muscle use, and normal breath sounds without wheezing.  

At the 17 September 2003 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported pain and tenderness of the right chest and occasional difficulty (“tightness”) taking deep breaths on exertion and with exercise.  The physical examination showed clear breath sounds without wheezing, and no tenderness over the indicated area.  Radiographic evaluation (X-Ray) showed no evidence of lung infiltrates, masses, or cavities.  Pulmonary function testing (PFT) documented a forced expiratory volume in 1 second (FEV-1) of 78%, and an FEV-1/ forced vital capacity (FVC) of 107%, suggestive of a mild restrictive ventilatory impairment.  Diffusion capacity (DLCO) was 76%, and described as “within normal limits.”  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the lung condition 10%, coded 6899-6845 (pleural effusion or fibrosis).  The Navy PEB also listed “right sided pleurisy,” “recent right pneumothorax,” “bilateral pneumonia resolved,” and “right pleural effusion vs scar” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these conditions was properly subsumed under the overall rating for the right lower lobe pneumatocele condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated 10% for “scar, residuals of pulmonary disease,” coded 6844-7804 (scars, unstable or painful), based on the C&P examination 6 months after separation, citing “normal examination and no radiographic evidence of pleural effusion or other residual.”  

The panel considered the evidence for rating.  IAW VASRD §4.100 General Rating Formula for Restrictive Lung Disease, codes 6843 (traumatic chest wall defect), 6844 (post-surgical residual) and 6845 (chronic pleural effusion or fibrosis) are rated based on PFTs or diffusion capacity of the lung.  The PEB and VA examinations proximate to separation demonstrate the CI’s lung condition was most closely aligned with 10% rating criteria.

No other coding options were applicable nor of benefit to the CI.  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 lung condition.  

BOARD FINDINGS:  In the matter of the right lower lung pneumatocele 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 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 20150706, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

	
						 XXXXXXXXXXXXXXXXXX