RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX                                                                             CASE:  PD-201502101
BRANCH OF SERVICE: ARMY                                                                   SEPARATION DATE:  20000311
DATE REMOVED FROM TDRL:  20050311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 03, Aviator, medically separated from the Temporary Disability Retired List (TDRL) for “malignant melanoma of the parotid gland” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20050527	VARD - 20001127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Malignant Melanoma of the Parotid Gland…	7833	0%	Melanoma Left Parotid Gland	7399-7343	100%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Malignant Melanoma of the Parotid Gland.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented with an enlarged parotid gland (a salivary gland) in November 1998.  A fine needle biopsy showed the presence of cancerous cells.  The CI then underwent a radical neck dissection on 17 December 1998.  Pathology revealed the presence of malignant melanoma.  One lymph node was positive, but staging evaluations were otherwise negative.  The CI was begun on chemotherapy and effective 11 March 2000, placed on TDRL.  The CI was continued on TDRL following re-evaluations in 1999, 2000, and 2002.  
The final TDRL NARSUM dated 3 January 2005, 5 months prior to TDRL removal, noted that the CI had been on post-operative chemotherapy for 9 months and then changed to quarterly immunotherapy.  He had no evidence of recurrent disease and reported no toxicity from his treatment.  His physical examination was unremarkable and the left neck surgical scar was noted to be well healed.  Although he had been disease free for 5 years, he remained on agents (for prophylaxis) which were not approved for aviation duties by the service.  The CI was removed from TDRL effective 11 March 2005.  At the oncology clinic appointment on 14 April 2005, 1 month after removal from the TDRL, the examiner recorded that the CI had been treated by immunotherapy (IT) alone for the past 3 years.  The CI was considered to be in remission, but continuation of IT for a total of 10 years was recommended as it was possible that undetectable disease remained and the CI was still young with an estimated 50 year life expectancy remaining.  There were no further clinical entries.  The only VA compensation and pension (C&P) examination was dated 7 December 2012.  It noted that the CI was disease free and had not had any treatment since 2003, 2 years prior to TDRL removal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under code 7833 (malignant melanoma), citing “soldier has remained 5 years without evidence of recurrence of his cancer.”  It noted that he was disease free, but remained on prophylactic treatment.  The VA rating decision dated 27 November 2000, assigned a 100% rating using the analogous 7399-7343 code (malignant neoplasms of the digestive system, exclusive of skin growths) based on service treatment record, citing “active malignancy or antineoplastic therapy.”  This was not reconsidered until 2013 when the rating was reduced to 0% for the melanoma, effective 1 May 2014.  Both the codes 7343 and 7833 assign a 100% rating for the duration of treatment and for 6 months afterwards.  In this case, the CI stopped treatment several years prior to TDRL removal even though he remained on prophylaxis afterwards.  Neither code supports a rating higher than the 0% adjudicated by the PEB (and later the VA).  In addition, there was no evidence of ratable residuals.  The surgical scar was not found to be either medically unacceptable or unfitting.  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 malignant melanoma condition.  

PANEL FINDINGS:  In the matter of the malignant melanoma and IAW VASRD §4.114 and 4.118, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294 dated 20150715, with attachments
Exhibit B.  Service Treatment Record

Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014667, 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,					      
						      					
Enclosure