RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-02673
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Security Forces Craftsman, medically separated for “local disseminated coccidioidomycosis associated with secondary anemia” with a disability rating of 10%.  

CI CONTENTION:  “I would like all my MEB/PEB conditions considered for being unfit for duty and rated.”  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 - 20060307	VARD - 20070714	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Local Disseminated Coccidioidomycosis	7899-7820-7806	10%	Coccidioidomycosis	6835	50%	20070216	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Local Disseminated Coccidioidomycosis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s coccidioidomycosis (valley fever or fungus found in soil which can cause infection if inhaled) began in December 2002.  The CI first complained of cough, low-grade fever and myalgias (muscle pain).  He then developed night sweats and was diagnosed with having bronchitis and treated with antibiotic, which did not resolve his symptoms. In February 2003, his fever spiked to 104 degrees and he was transported to the emergency room (ER).  A chest X-ray showed patchy infiltrates and tracheal adenopathy.  A chest CT scan showed post-obstructive pneumonitis (inflammation of lung walls) and enlarged right paratracheal area (lymph node) and mediastinum (partition between the lungs).  Blood chemistry demonstrated several abnormalities that led to a bone marrow biopsy, which identified coccidioides immitis.  The CI was started on anti-fungal medication.  In November 2003, the CI had recurring symptoms with right cervical lymphadenopathy (lymph node inflammation) and cough for 2 months.  The CI was told by his primary care physician that he had the “common cold.”  His anti-fungal medication was discontinued for no apparent reason except “exceeded his 6 months of therapy.”  

In December 2003, the CI was referred to surgery for aspiration and biopsy of growing right cervical adenopathy (lymph node), which was presumed to be recurrent coccidiomycosis.  His medication was restarted.  The CI ran out of medication in February 2004, and in April he went to the ER due to purulent (milky) drainage from the biopsy site.  The anti-fungal medication was resumed at a low dose.  The CI continued with a pattern of recurrence in the absence of medication; therefore, long-term medication was implemented.

The 5 December 2005 MEB NARSUM examination, 5 months prior to separation, noted less periodic exercise intolerance and felt he was close to his baseline health, but had occasional night sweats.  A review of systems recorded absence of fever, cough, wheezing, hemoptysis and shortness of breath.  Physical examination showed normal vital signs, no cervical or supraclavicular adenopathy (no evidence of inflammation) and clear chest.  All other aspects of the examination were unremarkable.  The examiner diagnosed local disseminated coccidiomycosis and chronic normocytic anemia secondary to coccidiomycosis.  The condition was documented as clinically stable with a high dose of Fluconazole daily (800mg) to treat and prevent fungal infections.  The examiner indicated that the high dose of medication could be reduced if the CI remained stable or improved.

At the 16 February 2007 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported being re-evaluated by infectious disease and had not had any recurrence of his coccidiomycosis symptoms since discharge from service.  His suppressive antifungal medication dose had been reduced to 200mg daily and he participated in annual titers (vaccinations) and monitoring for disease activity.  Physical examination was unremarkable.  The examiner documented the CI’s coccidiomycosis condition was successfully being managed by daily suppressive antifungal therapy (medication).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the coccidioidomycosis 10%, dual coded 7820-7806 (infections of the skin not listed elsewhere-dermatitis or eczema), citing no active disease on CT.  The VA rated the coccidioidomycosis 50%, coded 6835 (coccidioidomycosis), based on the C&P examination, citing chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough.

Panel members first deliberated and agreed the CI’s diagnosed local disseminated coccidioidomycosis (pulmonary and cervical) was best coded under 6835.  A 50% rating requires “chronic pulmonary mycosis [fungal infection of lung tissue] requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough.”  A 30% rating entails, “chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough.”  The panel agreed the CI had chronic coccidiomycosis (pulmonary and cervical) requiring suppressed therapy (medication) with minimal productive cough symptoms, as recorded on the MEB NARSUM and VA examinations.  Additionally, the STR evidence showed that the CI’s coccidioidomycosis symptoms worsened when the antifungal suppressive therapy was removed.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the coccidioidomycosis, coded 6835.
BOARD FINDINGS:  In the matter of the coccidioidomycosis, the panel recommends a disability rating of 50%, coded 6835 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Local Disseminated Coccidiomycosis 	6835	50%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170317, 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

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Dear XXXXXXXXXX,

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02673.

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.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-xxxx to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.