RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00354
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “paradoxical vocal fold motion” with a disability rating of 0%.  

CI CONTENTION:  “Unfit for duty due to breath disorder while serving in Iraq.”  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 - 20060324	VARD - 20060525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Paradoxical Vocal Fold Motion	6520	0%	Spastic Dystonia	6599-6516	10%	20060316	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Paradoxical Vocal Fold Motion (PVFM).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s vocal fold (VF) condition began in January 2004 with no history of trauma or inhalational exposure.  Evaluation by direct visualization (laryngoscope) in December 2004, October 2005, and January 2006 showed abnormal VF motion but no vocal cord thickening, nodules, or polyps.  Pulmonary function testing (PFT) in April 2005 revealed moderately severe paradoxical vocal cord motion (PVCM) obstructive disorder (actual results not in evidence).  June 2005 PFTs showed a forced expiratory volume in 1 second (FEV-1) of 69%.  Throughout the STR, the CI’s speech was described as having frequent breaks (aphonia) with no significant improvement after speech therapy and VF injections.  

At the 6 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the CI reported shortness of breath while exercising and the examiner documented frequent interruptions in speech.  The 10 February 2006 MEB NARSUM examination noted the CI’s inability to perform aerobic exercise or light jogging for any extended period of time.  Physical examination showed a strained voice with frequent breaks, normal pitch, and mildly reduced volume.  PVFM was observed on direct visualization.  

At the 16 March 2006 VA Compensation and Pension (C&P) C&P evaluation, 1 month prior to separation, the CI reported difficulty with talking and the inability to run because of trouble breathing over the last 2 years.  Direct visualization showed persistent PVFM without any areas of narrowing, masses, or other lesions.  PFTs documented an FEV-1 of 49-55% on 16 March 2006 (worsening after bronchodilation therapy) and 81% on 23 March 2006.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the PVFM condition 0%, coded 6520 (larynx, stenosis of), citing normal vocal pitch, mildly reduced volume, and FEV-1 of 81.4%.  The VA rated the spastic dystonia condition 10%, analogously coded 6599-6516 (laryngitis, chronic), based on the C&P evaluation 1 month before separation, citing good vocal cord movement and no nodules or polyps.  Members noted a higher rating under code 6520 was not supported with an FEV-1 over 80%, but agreed the condition did warrant a 10% rating under code 6516.  There was no evidence of constant inability to speak above a whisper for a higher rating under code 6519 (aphonia, complete organic).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the PVFM condition, coded 6516.  

BOARD FINDINGS:  In the matter of the PVFM condition, the panel unanimously recommends a disability rating of 10%, coded 6516 IAW VASRD §4.97.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Paradoxical Vocal Fold Motion	6516	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015422, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure