RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01634
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Vehicle Operator Apprentice, medically separated for “vocal cord dysfunction” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060221	VARD - 20060901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vocal Cord Dysfunction (VCD)	6599-6520	10%	Vocal Cord Dysfunction	6599-6519	NSC	20060615	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Vocal Cord Dysfunction (VCD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s vocal cord condition began in October 2002 during the first weeks of basic training when he had an acute upper respiratory infection and shortness of breath.  He was seen several more times over the next few months, but able to complete training.  

On 9 June 2003, the CI was evaluated in pulmonary medicine for ongoing complaints of shortness of breath at rest and with exertion.  The examination and testing were consistent with VCD and without evidence of asthma or a restrictive lung disease.  He was referred to a speech pathologist who confirmed a diagnosis of VCD; breathing exercises and biofeedback were recommended.  The CI was referred for an MEB for anxiety with VCD and returned to duty by a PEB on 30 September 2003.  He remained symptomatic, albeit less so, but was not deployable due to increased symptoms in stressful situations and the inability to wear chemical protective gear; he did not miss work and was able to meet duty requirements in garrison.  His commander recommend cross training into another career field and he was then referred for a second MEB. The 29 November 2005 MEB NARSUM examination, 5 months prior to separation, noted the above history.  Physical examination showed no acute distress or abnormal breath sounds.  At the 15 June 2006 VA Compensation and Pension (C&P) general examination, 2 months after separation, the CI reported occasional VCD that caused chest tightness for a few minutes.  Physical examination showed that the CI was not short of breath or hoarse and talked normally.  

The panel directed attention to its rating recommendation based on the above evidence.  The Informal PEB rated the vocal cord condition as an EPTS [existed prior to service] condition, but a subsequent Formal PEB conceded service aggravation and rated it at 10%, analogously coded 6599-6520 (larynx, stenosis of, including residuals of laryngeal trauma).  The VA did not service-connect the vocal cord condition, analogously coded 6599-6519 (aphonia, complete organic), based on the C&P general examination, citing no vocal cord dysfunction found during the evaluation.  The pulmonary function tests were normal although indicative of an upper airway obstruction (VCD).  The CI was not hoarse on examination.  The panel found no criteria warranting a compensable rating, but does not recommend a combined rating lower than that adjudicated by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the vocal cord condition.  

BOARD FINDINGS:  In the matter of the vocal cord dysfunction condition and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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-2017-01634.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

	

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings