RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02591
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Structural Repairer, medically separated for “restrictive lung disease,” with a disability rating of 10%.

CI CONTENTION:  “I believe while being medically discharged I received an unfair rating.”  “Review all conditions.” The CI’s 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 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 determinations 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 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 - 20040109	VARD - 20041117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Restrictive Lung Disease	6845	10%	Restrictive Lung Disease	6899-6840	0%	20040319	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Restrictive Lung Disease Condition.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s dyspnea (shortness of breath) on exertion (DOE) began approximately 3 years prior to referral for MEB.  A 25 January 2001 clinic encounter documented the CI “was running a PT test when his chest started hurting and it became hard to breath.  He then started coughing up blood (described as white saliva c [with] flecks of blood).”  The 25 January 2001 chest X-ray was normal.  At the 5 February 2001 pulmonary nuclear medicine ventilation/perfusion (V/Q) scan (assess for pulmonary embolism) showed no evidence of segmental perfusion defect to suggest pulmonary embolism.  On 2 August 2001 internal medicine performed a graded exercise stress test (GXT).  The findings were “Overall good GXT.  Shortness of breath could be exercise induced bronchospasm (EIB).”  The 17 September 2001 baseline pulmonary function tests (PFTs) recorded the forced expiratory volume in 1 second (FEV-1)/forced vital capacity (FVC) was 88 percent, and the FEV-1 was 81 percent predicted.  The pharmacologic (Methacholine) challenge (inhaled provocative agent to elicit bronchoconstriction to assess for asthma) caused a 10% decrease in FEV-1 and was interpreted as negative (positive > 20% decrease in FEV-1).  The 26 March 2002 PFTs revealed the FEV-1 was 85 percent predicted, and the FEV-1/FVC was 88 percent.  The pulmonologist interpreted the spirometry (measure of lung function in terms of volume and/or flow of air inhaled and exhaled) as showing moderate restrictive ventilatory defect on lung volumes.  The 18 December 2002 high resolution chest computed tomography (CT) study showed no definitive evidence of pulmonary interstitial or alveolar processes.  The cardiopulmonary exercise study performed in June 2003 was consistent with deconditioning.  The 6 June 2003 PFTs revealed the FEV-1 was 79 percent predicted, and the FEV-1/FVC was 86 percent.  The diffusing capacity of lungs for carbon monoxide (DLCO) (measure of gas transfer from lungs [alveoli] to blood [red blood cells]) was 81 percent.  The pulmonologist interpreted the spirometry as showing mild restrictive ventilatory defect on lung volumes and the DLCO at the upper limits of normal.  The 16 June 2003 echocardiogram was normal.  The 17 November 2003 PFTs revealed the FEV-1 was 87 percent predicted, and the FEV-1/FVC was 84 percent.  The pulmonologist interpreted the PFTs as spirometry within normal limits, a normal diffusion capacity, and lung volumes consistent with a moderate restrictive ventilatory defect.  The 9 September 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, documented “CURRENT MEDICATIONS (Prescription and Over-the-counter) none.”  

The 3 December 2003 MEB NARSUM examination by pulmonology, 7 months prior to separation, recounted the history, extensive workup, and findings.  The CI complained persistent exertional dyspnea and denied any significant childhood respiratory symptoms.  He was initially managed as an asthmatic, but his testing was more consistent with a restrictive, rather than an obstructive picture.  “In view of his symptoms and the need to further delineate the etiology of his interstitial lung disease, a fiber optic bronchoscopy with biopsy was undertaken.  The biopsy and lavage findings were inconclusive.”  The CI was taking no medications at time of evaluation.  The physical examination documented respirations at 18 breaths/minute.  The chest examination revealed a normal inspiratory to expiratory ratio and the bilateral lungs were clear to auscultation.  The extremity examination revealed no clubbing (pathological enlargement of digits from pulmonary or cardiovascular diseases), cyanosis (bluish discoloration from insufficient oxygen), or edema (excess tissue fluid swelling).  The examiner recounted the findings of the X-rays, CTs, V/Q scan, PFTs, GXT, and echocardiogram.  The pulmonologist opined “Despite an extensive pulmonary workup, no clear etiology has been found to explain his moderate restrictive defect.  In clinical testing, the patient does have an element of deconditioning, but no other pulmonary or cardiac etiologies can be found to cause his symptomatic dyspnea.”  The diagnosis listed restrictive lung disease, moderate.  

The 29 March 2004 VA compensation and pension (C&P) evaluation, 3 months before separation, recounted the history and interventions.  The CI complained of shortness of breath and discomfort with running.  He had previously been treated for asthma symptoms, however this proved to be unsuccessful, and all medications were discontinued.  “Currently he is not requiring any treatment for this condition and remains essentially asymptomatic with the exception of periods of exertion such as running.”  The physical examination documented respirations at 20 breaths/minute.  The chest examination revealed symmetrical respiratory movement and shape.  The lung examination revealed the bilateral lung fields were clear to auscultation and breath sounds were symmetrical and of good quality.  The examiner recounted the findings of the X-rays, CTs, V/Q scan, PFTs, and bronchoscopy.  The diagnosis listed moderate restrictive lung disease.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6845 code (chronic pleural effusion or fibrosis) citing restrictive lung disease and FEV-1/FVC of 78%.  The VA assigned a 0% rating under an analogous 6840 code (diaphragm paralysis or paresis) based on the VA C&P examination 3 months before separation, citing restrictive lung disease, lungs clear to auscultation,  17 November 2003 PFTs (FVC of 81 percent, FEV-1 of 87 percent, and FEV-1/FVC of 84 percent) and a non-compensable evaluation is assigned unless there is a FEV-1 of 71 to 80 percent of predicted value, or FEV-1/FVC of 71 to 80 percent, or DLCO of 66 to 80 percent predicted.  While serial PFTs were consistent with a mild/moderate restrictive ventilatory defect, they were otherwise unremarkable.  The panel agreed the serial PFTs did not achieve the minimum 10% rating (FEV-1 of 71 to 80 percent of predicted value, or FEV-1/FVC of 71 to 80 percent, or DLCO of 66 to 80 percent predicted) under the General Rating Formula for Restrictive Lung Disease (diagnostic codes 6840 through 6845).  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 lung condition and IAW VASRD §4.71a, 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 20151223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013338, XXXXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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