RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02218
BRANCH OF SERVICE:  Coast Guard	SEPARATION DATE:  20021013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Maintenance Technician, medically separated for “right tympanic membrane perforation” with a disability rating of 0%.

CI CONTENTION:  The CI contends right tympanic membrane perforation, bilateral eustachian tube dysfunction, spinal cord bend with brain decompression sickness and mental health 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 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 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 determinations is based upon a 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 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 - 20020530	VARD - 20030925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tympanic Membrane Perforation	6211	0%	Repeat Tympanic Membrane Perforations	6211-6200	10%	20030523	
Eustachian Tube Dysfunction, Bilateral	Not Unfitting	No VA Placement	
Spinal Cord Bend	Not Unfitting	Brain Decompression Sickness and Spinal Cord Bend...	8045-5290	0%	20030520	
Brain Decompression Sickness						
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Tympanic Membrane Perforation.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right tympanic membrane (TM) perforation first occurred in May 1996 after being placed in a hyperbaric chamber to treat a suspected exposure to carbon monoxide.  The CI had multiple other right TM ruptures (appears to be 5 in all).  Due to the suspected cause of her TM ruptures being eustachian tube dysfunction, she was treated with pressure equalization (PE) tubes and in 2001 a tympanoplasty; however, she continued to have complaints of intermittent ear pain and difficulty equalizing pressure across her TMs.  In May of 2001 she was disqualified for aviation service and referred to the MEB.  

At the 17 January 2002, 9 months prior to separation, biennial aircrew examination the CI reported she was in good health and on no medication.  Physical examination revealed poor movement of both ear drums with Valsalva maneuver.  The examiner reported the presence of a “tenuous patch” on the right ear drum.  

The 5 February 2002 Audiology evaluation performed in conjunction with the MEB, 8 months before separation, noted complaints of hearing loss.  The examination showed a type Ad tympanogram on the right indicating increased compliance of the ear drum.  The pure tone threshold audiogram results demonstrate an H-1 hearing profile.  

At the 20 May 2003 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported that she could do all regular activities.  She reported her previous history of TM perforations and a patch of the right TM in 2001.  The CI related a history of vertigo and tinnitus, which resolved spontaneously.  In addition, she stated that if she were to get water in the right ear it caused drainage.  Physical examination showed scarred right TM without perforation.  An audiogram showed a mild conductive hearing loss in the right ear similar to the audiogram prior separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right tympanic membrane condition 0%, coded 6211 (tympanic membrane, perforation).  The VA rated the right tympanic membrane condition 10%, analogously coded 6211-6200 (tympanic membrane, perforation - chronic suppurative otitis media, mastoiditis, or cholesteatoma) based on the VA C&P examination 7 months after separation, citing ear drainage.  

Panel members noted there was evidence of multiple TM perforations and a tympanoplasty was performed to repair a chronic perforation.  Prior to separation the right TM was intact and was noted to still be intact at the VA C&P evaluation 7 months after separation.  The panel recognized that the only rating available for code 6211 (tympanic membrane, perforation of) is 0%.  At both the biennial aircrew examination and the VA C&P evaluation there was no evidence of infection of either the inner or outer ear and no drainage was noted to rate using 6200 (chronic suppurative otitis media, mastoiditis, or cholesteatoma) or 6210 (chronic otitis externa).  The temporary dizziness and tinnitus had resolved; therefore, the panel was unable to rate using codes 6204 (peripheral vestibular disorders), or 6260 (tinnitus, recurrent).  

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 right tympanic membrane perforation condition.  

Contended PEB Conditions:  Eustachian Tube Dysfunction, Bilateral, Spinal Cord Bend and Brain Decompression Sickness.

The panel’s main charge is to assess the fairness of the PEB’s determination that spinal cord bend, brain decompression sickness and eustachian tube dysfunction, bilateral were not unfitting.  There is no profile or commander’s statement in evidence to assist with the fitness for duty and retention determination.  Panel members agreed that the eustachian tube dysfunction was disqualifying for further aviation duties but not for continued service in an alternate rate.  The panel reviewed the evidence concerning the spinal cord bend and brain decompression sickness and found that according to the aeromedical summary of 20 February 1998 all symptoms resolved with hyperbaric oxygen treatment and there was no recurrence of symptoms.  There was no performance-based evidence from the record that the history of spinal cord bend and brain decompression sickness significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for spinal cord bend, brain decompression sickness and eustachian tube dysfunction, bilateral and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right tympanic membrane perforation condition and IAW VASRD §4.87, the panel unanimously recommends no change in the PEB adjudication.  

In the matter of the contended spinal cord bend, brain decompression sickness and eustachian tube dysfunction, bilateral conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  

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 20150627, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX,

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2015-02218) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at XXXXXXXXXXXXXXXXXXX. 

Sincerely,

                   	XXXXXXXXXXXXXXXXXXX
                                                                                    Rear Admiral, U. S. Coast Guard
                                                                                   Assistant Commandant for Human Resources

2 Enclosures	

Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs