RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02332
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20090210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantry Gun Crews and Seamanship Specialist, medically separated for “Group A strep pneumonia with mild residual restrictive lung disease” 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 - 20081029	VARD - 20090326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pneumonia with Mild Residual Restrictive Lung Disease	6699-6600	10%	Chronic Obstructive Pulmonary Disease with Bilateral Pleural Effusion …	6604	0%	20090105	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Group A Strep Pneumonia with Mild Residual Restrictive Lung Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed an upper respiratory infection in the summer of 2007 (early in basic training) that progressed to a severe pneumonia with a complicated clinical course.  It resulted in prolonged hospitalization requiring mechanical ventilation and thoracostomy (chest tube drainage) for a large pleural effusion (fluid in the chest); and, was complicated by sepsis, renal failure, anemia, and hospital-acquired infection (MRSA).   He eventually recovered very well, with resolution of all the above complications; but, was left with residual lung damage and mild restrictive pulmonary disease that rendered him unable to satisfy Navy physical fitness requirements.   

There were serial pulmonary function test (PFT) results in evidence.  Measurements of FEV1 (all post-bronchodilator) ranged from an initial 74% to a final (1 month before separation) 81% predicted, and the FEV1/FVC ratio ranged from an initial 99% to a final 105%.  There were no measurements of DLCO (diffusion capacity for carbon monoxide).  Final imaging (CT) demonstrated “some mild pleural scarring” without further abnormality (pleural effusion resolved).  There was STR evidence (including cardiac ECHO and consultant opinions) that refuted the presence of cor pulmonale, right ventricular hypertrophy, or pulmonary hypertension (VASRD criteria for higher ratings).  

The 16 September 2008 NARSUM examination, 5 months prior to separation, documented improved symptoms, with no cough or fevers, but some residual chest pain and a decreased exercise tolerance that prohibited the CI from running.   The physical examination recorded normal pulmonary and cardiovascular findings and healed surgical scars.  The NARSUM cited the initial PFT results as above.  

The 5 January 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, documented exertional shortness of breath but no cough, fevers, chest pain or other residual symptoms.  The physical examination was normal with clear lungs and a normal expiratory phase (no bronchospasm).  The C&P cited the final PFT results as above.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 6699-6600 (analogous to chronic bronchitis) did not provide a rationale; but, based on the PFT evidence cited in the NARSUM, was consistent with the 10% criteria of code 6600, “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted.”  The VA rated under code 6604 (chronic obstructive pulmonary disease) subject to the same criteria as code 6600, and its 0% determination was consistent with the PFT evidence cited in the C&P.

There is no code available under VASRD §4.97 (respiratory system) that is an exact clinical match with this case, but any applicable analogous choice would fall under the same general rating formula for restrictive lung disease.  The 10% criteria are quoted above and the 20% criteria are “FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent” plus the same DLCO criterion.  The evidence thus did not support §4.97 criteria for a rating higher than 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 pulmonary condition.  

BOARD FINDINGS:  In the matter of the streptococcal pneumonia with mild residual restrictive lung disease and IAW VASRD §4.97, 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 20150603, w/atchs
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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting