RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE: pd-2016-00460 
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20061222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air Force  active duty, E3, Tactical Aircraft Maintenance Apprentice,  medically separated for “profound sensorineural hearing loss, left ear, due to meningitis,” with a disability rating of 10%.  

CI CONTENTION:  Multiple conditions contended due to traumatic brain injury from meningitis.  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 - 20061018	VARD - 20070816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Profound Sensorineural Hearing Loss, Left Ear, due to Meningitis	6100	10%	Bilateral Hearing Loss	8019-6260	20%	20070619	
Meningitis	Not Rated	No VA Claim in Record	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Profound Left Ear Sensorineural Hearing Loss due to Meningitis.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s profound sensorineural hearing loss condition began in December 2005 as a result of pneumococcal meningitis (a bacterial infection).  He awoke with a headache, fever, and vomiting and was admitted and treated with intravenous antibiotics (cefotaxime and Levaquin (levofloxacin)), intubated for 10 days and hospitalized for 21 days.  As a result he became deaf in the left ear.  On 13 December 2005 a computerized tomography (CT) scan demonstrated what was determined to be encephalocele (sac-like protrusion of the brain) that protruded into the left ethmoid sinus.  It was resected on 17 April 2006 via nasal endoscopy and was closed in layers with placement of a lumbar drain.  On 12 May 2006 an audiology evaluation revealed a mild low frequency sensorineural hearing loss at 500 Hz-750 Hz in the right ear, sharply rising to within normal limits at 1000 Hz and above.  His word recognition score in the right ear was excellent.  Results for the left ear revealed a profound sensorineural hearing loss with no response to pure tones at the limit of the audiologist’s equipment.  Immittance measurements (to evaluate the eardrum and middle ear space and a muscle reflex) revealed normal (Type A) tympanograms for both ears.  Acoustic stapedial reflexes (muscle contraction in the middle ear in response to high-intensity sound stimuli) were present for the right ear and absent for the left ear.  These results were consistent with normal middle ear function for the type and degree of hearing in both ears.  

The CI was recommended to be fitted with a specialized wireless hearing aid which would allow him to hear sounds from his left side in his right ear.  It would not correct the problem with localizing sound, which was characteristic of this type of hearing loss. Because of increased background noise and difficulty localizing sound he was given a profile which kept him from the flight line.  On 22 June 2006 the CI was seen in postoperative follow-up after being cleared by his primary surgeon for resumption of activity.  On examination he was in no distress with cranial nerves intact, bilateral tympanic membranes clear and the nares clear bilaterally.  The right intranasal surgical site was clean and nicely mucosalized without any infection or defect.  The examiner’s assessment was a good result status post repair of the right encephalocele via the intranasal approach, and he noted the left hearing loss was permanent.  Smoking cessation was recommended.  On 20 July 2006 audiology evaluation reported profound hearing loss (most likely sensorineural) for the left ear.  No response was obtained for speech in the left ear and speech discrimination was 80% in the right ear.

The 2 September 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of profound hearing loss in the left ear.  Physical examination showed the CI to be well, alert, oriented times three and in no obvious distress.  He responded to spoken voice without any difficulties with interpretation.  The ears, nose and throat were normal on inspection as was his pharynx.  On neurologic evaluation he had normal mood and affect.  He was deaf in the left ear, otherwise the cranial nerves were intact.  Audiogram results are in the chart below. The examiner noted that while functionally the CI had acceptable hearing abilities with his hearing aids in place, he lost directional clues from audio inputs, which questioned his ability to safely work on the flight line.  

There was no VA Compensation and Pension examination in evidence proximate to separation; however, the VA Rating Decision dated 16 August 2007 indicated the CI had a VA audio examination on 19 June 2007, the results of which are in the chart below.  Audiology evaluation on 12 March 2008, 15 months post-separation, noted the CI complained of trouble hearing with the hearing aids he received.  Pure tone test results revealed a moderate to normal conductive hearing loss for the right ear and the left ear was not useable.  Speech reception thresholds were in line with the pure tone results.  Speech discrimination for the right ear was 100% and the left ear could not be tested.  Impedance measurement for the right ear revealed a type C tympanogram (a middle ear with negative pressure).  Cross amplification was recommended.  

The hearing evaluations, in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

HEARING	EXAM	MEB  ~3 Mo. Pre Sep
	VA Audio Examination           ~6 Mo. After Sep
	
LEFT EAR	Average Hearing Loss	77.5 dB	90 dB	
	Speech Discrimination	0%	0%	
	Table VI / VIa	XI  VII	XI	
RIGHT EAR	Average Hearing  Loss	6.25 dB	24 dB	
	Speech Discrimination 	80%*based on exam 20060720	80%	
	Table VI / VIa	III 	IIII	
§4.85 RATING	Table VII	20%	20%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the profound left ear sensorineural hearing loss due to meningitis condition 10%, coded 6100 (hearing impairment).  The VA rated the bilateral hearing loss condition 20%, coded  in error as 8018-6100, which should have been 8019-6100 (meningitis-hearing impairment), based on the C&P audiology examination 6 months after separation, citing audiologic findings.  The panel took note of the many audiologic findings and were cognizant of the complete loss of hearing on the left and the disparate findings related to the right ear speech discrimination findings.  Nevertheless, 80% speech recognition seemed to be consistent between examiners.  Therefore, a 20% rating, and no higher, is reasonable at the time of separation, which is comparable with the VA rating based on audiometric findings 6 months post-separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the profound left ear sensorineural hearing loss due to meningitis condition, coded 6100.  

Contended PEB Condition:  Meningitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not explicitly profiled or implicated in the commander’s statement, which did note the CI had shown an inability to successfully perform duty requirements due to impaired hearing with a partial hearing loss in one ear and near total in the other.  After a long, but successful treatment of the pneumococcal bacterial meningitis, the CI had a period of double vision after coming out of sedation in the Intensive Care Unit, which improved greatly thereafter, while the profound hearing loss on the left persisted.  On 22 July 2006 the CI underwent psychoneurological evaluation following bacterial meningitis.  He demonstrated superior intellectual ability with excellent executive function, abstraction, problem-solving, and concept formation although the examiner noted evidence of a deficit in immediate and long-term memory functions, which were deemed very mild and were likely to improve over time.  The examiner’s diagnosis was dementia, very mild secondary to bacterial infection and situational adjustment disorder, unspecified.  The Global Assessment of Functioning score was 85 (absent or minimal symptoms).  There was no performance-based evidence from the record that the condition significantly interfered post treatment with satisfactory duty performance at separation, except for the hearing impairment.  At the VA examination on 17 July 2007, 7 months after separation, it was noted there were no significant effects on his usual occupation or activities of daily living.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB determination for the contended condition; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left ear profound sensorineural hearing loss due to meningitis condition, the panel unanimously recommends a disability rating of 20%, coded 6100 IAW VASRD §4.85 and VASRD §4.86.  

In the matter of the contended meningitis condition, the panel unanimously recommends no change from the PEB determination.  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	
Left Ear Profound Sensorineural Hearing Loss
due to Meningitis	6100	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00460.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR