RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01963
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20091123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Air Transportation Craftsman, medically separated for “mixed conductive and sensorineural hearing loss” with a disability rating of 0%.  

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 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 - 20090818	VARD - 20100426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mixed Conductive and Sensorineural Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	0%	20100108	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Mixed Conductive and Sensorineural Hearing Loss.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left ear surgery in March 2003, followed by right ear surgery in September 2003.  She had a repeat surgery to her right ear in March 2004 where she had prosthetic ossicles placed.  She then had a second surgery on her left ear in September 2004 for tube placement due to inability to clear her ear.  The tube subsequently spontaneously dislodged and was removed.  Due to cholesteatomas and surgical corrections the CI had mixed conductive and sensorineural hearing loss which required the use of bilateral hearing aids since 2005.  The CI was removed from a deployment and administratively removed from hazardous noise by her supervisor.  

The 10 April 2009 MEB NARSUM examination, 7 months prior to separation, noted complaints of hearing loss.  Physical examination showed bilateral multiple scarring of the tympanic membranes with loss of usual landmarks.  Examination of the left ear documented air conduction greater than bone conduction (abnormal).  There were no signs of infection and the nose and mouth appeared normal.  The 16 July 2009 audiology evaluation, 4 months prior to separation, documented occasional bilateral tinnitus without vertigo.  Audiograms showed mixed conductive and sensorineural hearing loss, with values summarized below.  Profile was H3 and bilateral hearing aids were required.  

At the 7 January 2010 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported bilateral hearing loss and denied vertigo.  History included bilateral cholesteatoma and bilateral ear surgeries including right ossicle reconstruction with mastoidectomy.  Physical examination showed a perforated right tympanic membrane, bilaterally reduced compliance on tympanometry and absent reflexes bilaterally (see chart below).  The VA examiner diagnosed mild to severe hearing loss in the right ear and moderate hearing loss in the left ear.  

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

HEARING	EXAM	Audiology  ~4 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
LEFT EAR	Average Hearing Loss	61 dB	51 dB	
	Speech Discrimination	96%	100%	
	Table VI	II	I	
RIGHT EAR	Average Hearing  Loss	68 dB	70 dB	
	Speech Discrimination 	96%	92%	
	Table VI	II	II	
§4.85 RATING	Table VII	0%	0%	
(Average hearing loss is the sum of pure tone thresholds at 1000, 2000, 3000, and 4000 Hz divided by four)

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the hearing loss 0%, coded 6100 (bilateral hearing loss), with VA rating based on the C&P examination, citing the audiology results.  

All examinations documented pure tone and speech discrimination that supported a 0% rating with use of Table VI and VII.  There was no exceptional hearing pattern for either ear IAW VASRD §4.86, and therefore Table VIa was not applicable.  The CI had no history of phonophobia, vertigo, or other evidence to support Meniere’s syndrome (endolymphatic hydrops) which could support a higher rating.  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 hearing loss.  

BOARD FINDINGS:  In the matter of the hearing loss and IAW VASRD §4.85, 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.  

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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01963.

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.