RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02394
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “exertional dyspnea from interstitial lung disease” and “obstructive sleep apnea [OSA],” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  Chemical exposure caused severe medical issues.  He also requested review of an additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20061005 	VARD – 20070611 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Interstitial Lung Disease	6832	0%	OSA and Interstitial Lung Disease	6847-6825	0%	STR	
OSA, Mild	6847	0%					
Mild PTSD	Not Unfitting	PTSD	9411	10%	STR	
Mild Right Hearing Loss	Not Unfitting 	Right Ear Hearing Loss	6100	0%	STR	
Low Back Pain (LBP)	Not Unfitting	Lumbosacral Strain with DJD	5242-5237	0%	STR	
Benign Pineal Cyst	Not Unfitting	Benign Pineal Cyst	7915	0%	STR	
Low HDL	Not Unfitting	No VA Placement	
Headaches 	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%  	

ANALYSIS SUMMARY:  

Exertional Dyspnea from Interstitial Lung Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s respiratory condition began in 2003 while deployed.  He reported a nonproductive cough which developed after exposure to sandstorms and toxic chemicals.  While provocative testing for asthma was negative and he initially maintained good exercise tolerance, this deteriorated over time.  Pulmonary function testing (PFT) on 1 February 2005 showed forced vital capacity (FVC) of 91% (normal).  The CI smoked one pack of cigarettes per day at the onset of symptoms and for several years thereafter.  He began an extensive evaluation by pulmonary and rheumatology specialists for interstitial lung disease which ultimately included a confirmatory high-resolution CT, a lung biopsy and serological testing.  He was deployed again during the evaluation and had progression of his symptoms while in-theater.  He redeployed back to his home station due to family issues, and in April 2006, pathology results showed an inhalational injury most consistent with damage from tobacco or petroleum products.  He was diagnosed with progressive interstitial lung disease.  

The 1 June 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of progressive shortness of breath and exercise intolerance unresponsive to treatment.  Physical examination showed a resting respiratory rate of 26 (12-18 is normal), but the lungs were clear and symmetrical.  

At the 31 January 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported progressive symptoms and needed to rest after going up one flight of stairs.  The provider recorded a respiratory rate of 17 and normal lungs, and X-rays showed no evidence of the interstitial lung disease, although the staples from a biopsy were seen.  The PFT showed an FVC of 91%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the interstitial lung disease 0%, coded 6832 (pneumoconiosis), citing “mild” disability IAW with paragraph B-15 of AR 635-40.  The VA combined the OSA and interstitial lung disease under a single 0% rating, dual coded 6847-6825 (OSA, diffuse interstitial fibrosis), based on the STR.  Members observed that ratings for interstitial lung disease are based on FVC or diffusing capacity of the lungs for carbon monoxide (DLCO).  The PFTs proximate to separation did not support a rating higher than 0%, which would require an FVC of 75-80%.  After due deliberation, considering all of 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 interstitial lung disease.  

OSA.  According to the STR and MEB NARSUM, the CI reported poor sleep and snoring during the evaluation for his lung disease.  A sleep study was performed on 20 April 2006 and confirmed the diagnosis of OSA.  He had three apneas (cessation of breathing from seconds to minutes) and 119 hypopneas (shallow to slow breathing), and met the criteria for use of continuous positive airway pressure (CPAP); however, he did not tolerate wearing a mask.  A review of the technician notes from a second study in May 2006 showed that the CI began the test at 2300 and left at 0034, stating that he could not sleep and did not know why he was there for the test.  

The MEB NARSUM examination noted complaints of fatigue, but the CI denied a history of daytime drowsiness and falling asleep at either work or at the wheel.  At the 4 July 2007 C&P evaluation, 8 months after separation, he reported snoring, but there was no clear evidence of apneic episodes (the sleep study was not available) or daytime somnolence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OSA 0%, coded 6847 (OSA) citing application of DoDI 1332.39 rating guidance, which differed from VASRD rating criteria.  As stated above, the VA rated the comorbid OSA and interstitial lung disease 0% under dual code 6847-6825, citing no reports of hyper-somnolence.  A 30% rating is warranted for the presence of persistent daytime hyper-somnolence, however the CI denied excessive sleepiness.  A minimum rating of 50% for OSA requiring a breathing assistance device is supported by VASRD §4.97, but the CI did not use CPAP and remained free of hyper-somnolence.  After due deliberation, considering all of 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 OSA.  

Contended PEB Conditions:  Mild PTSD, Mild Right High Frequency Hearing Loss, LBP, Benign Pineal Cyst, Low HDL and Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the interstitial lung disease and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  In the matter of the OSA and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  In the matter of the contended mild PTSD, mild right high frequency hearing loss, LBP, benign pineal cyst, low HDL and headaches, the panel recommends no change from the PEB determinations as not unfitting.  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 20170303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010797, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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