[AR Number], XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04610
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “tinnitus” and “impairment of auditory acuity,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “Hearing and tinnitus getting worse.  Shoulder separation.”  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 - 20081223	VARD - 20100607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tinnitus	6260	10%	Tinnitus 	6260	10%	20100504	
Impairment of Auditory Acuity	6100	0%	Bilateral Hearing Loss 	6100	0%	20100504	
Bicipital Tendonitis, Improved	Not Unfitting	Right Shoulder (AC Separation)	5201	0%	20100504	
		Left Shoulder Pain	5299-5201	NSC	20100504	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Tinnitus and Impairment of Auditory Acuity.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral tinnitus and hearing loss began in December 2006 after significant noise exposure while deployed to Iraq.  An audiogram on 12 February 2008 showed average pure tone loss of 36.25 dB in the right ear and 47.5 dB in the left ear.  An MRI of the brain and anterior auditory canals in March 2008 was normal, and the CI was fitted for hearing aids in April 2008 and given a P3 profile.  Evaluation on 11 July 2008 documented the right ear at 36.25 dB and left ear at 53.75 dB.  The 15 September 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of hearing loss and tinnitus.  Physical examination showed tympanic membranes were clear bilaterally.  

At the 4 May 2010 VA Compensation and Pension (C&P) examination, 14 months after separation, the CI reported tinnitus and hearing loss.  Bilateral test results showed no evidence of middle ear pathology with good inter-test consistency and hearing loss assessed as sensorineural.  The audiology results are summarized in the chart below.  

HEARING	EXAM	MEB ~5 Mo. Pre Sep	VA C&P ~2 Mo. After Sep	
LEFT EAR	Average Hearing Loss	47.5 dB	49 dB	
	Speech Discrimination	76%	84%	
	Table VI / VIa	III (or IV fr July 2008)	II	
RIGHT EAR	Average Hearing  Loss	31 dB	31 dB	
	Speech Discrimination 	96%	84%	
	Table VI / VIa	I	II	
§4.85 RATING	Table VII	0%	0%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the tinnitus 10%, analogously coded 6260 (tinnitus), citing recurrent symptoms; and, rated the auditory acuity condition 0%, analogously coded 6100 (hearing loss) citing VASRD §4.85 Evaluation of Hearing Impairment.  The VA also rated the tinnitus condition 10%, analogously coded 6260, based on the C&P examination, citing recurrent tinnitus; and also rated the auditory acuity condition 0%, analogously coded 6100,  citing Table VII of 38 CFR §4.85 by intersecting row II, the better ear, with column II, the poorer ear.  Panel members noted that all examinations documented complaints of bilateral tinnitus and that the 10% adjudicated by the PEB is the highest VASRD rating available for tinnitus, whether the sound is recurrent or constant and perceived in one ear, both ears, or in the head.  All audiograms and speech discrimination tests proximate to separation warranted a 0% rating use Tables VI and VII, and there was no exceptional hearing impairment (IAW §4.86).  The CI had no history of phonophobia or diagnosis of Meniere’s syndrome (endolymphatic hydrops) which could support any higher rating for tinnitus or for auditory deficiency.  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 tinnitus or for the auditory acuity condition.  

Contended PEB Condition:  Bicipital Tendonitis, Improved (Left and Right Shoulders).  The panel’s main charge is to assess the fairness of the PEB determinations that the contended condition was not unfitting.  No shoulder condition was profiled or implicated in the commander’s statement, nor failed retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the tinnitus and impairment of auditory acuity conditions and IAW VASRD §4.87 the panel majority recommends no change in the PEB adjudication.  In the matter of the contended bicipital tendonitis (left and right) conditions, 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: