RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05742
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “[right] recurrent episodic otalgia with normal hearing” and “vertigo,” rated 10% each, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The conditions continue to worsen.  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 - 20071218	VARD - 20080904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Right] Recurrent Episodic Otalgia 	6299-6200	10%	Ear Pain, Bilateral	6299-6200	NSC	20080711	
Vertigo	6204	10%	Recurrent Episodic Otalgia with Vertigo	6299-6200	NSC	20080711	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Recurrent Episodic Otalgia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right ear condition began in September 2007 after a co-worker sounded a blow horn and played the siren next to her right ear.  The CI noticed blood in her ear the next day.  She was evaluated 1 week later and reported hearing loss, pressure sensation and ringing (tinnitus) in her right ear.  Physical examination showed otosclerosis (an abnormal growth in the middle ear which causes hearing loss due to the inability to amplify sound) thought to be secondary to the use of pressure equalization tubes (PET, used for recurrent ear infections).  Bilateral tympanic membranes (eardrums) were intact and there was not mastoid tenderness.  She also reported dizziness (vertigo) and was referred to an otolaryngologist.  Physical examination noted normal hearing.  Both eardrums moved well on observation and impedance testing.  Ear canals were dry consistent with mild eczema.  She continued to be symptomatic and was seen in otolaryngology on follow up on 16 January 2007.  She reported right ear pain and dizziness aggravated by noise.  Physical examination remained unremarkable and her hearing improved from the prior visit.  The examiner found no ontological (ear related) cause of her symptoms.  The CI was seen by a different otolaryngologist on 15 March 2007.  The CI reported ongoing right ear pain and vertigo.  Physical examination was unremarkable other than the otosclerosis previously noted.  An MRI of the brain and internal auditory canals was normal.  She was prescribed Meclizine (vertigo and motion sickness medication).  She also noted having headaches secondary to the right ear pain and took Midrin (for headaches) which resulted in resolved headaches and ear pain.  The physical examination by otolaryngology on 3 October 2007 was stable from the prior evaluation to include a normal hearing test.  

The 9 October 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of right ear noise-induced, sharp and throbbing pain with a popping sensation.  The pain radiated to the right side of her head.  The CI reported this pain was associated with her tinnitus and vertigo conditions.  There were no complaints of staggering recorded.  Physical examination was unremarkable other than the otosclerosis.  

At the 11 July 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported sharp right ear pain.  Physical examination and hearing test were within normal limits.  The hearing test showed no change from the service entry test in 2005.  Her gait and balance were normal.  There were no complaints of staggering recorded.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ear condition 10%, coded 6200 (chronic suppurative otitis media, mastoiditis or cholesteatoma).  The VA did not service-connect the right ear condition, analogously coded 6299-6200, based on the C&P examination, citing the condition was neither occurred in or caused by service.

Despite an extensive evaluation, the panel agreed the right ear and vertigo etiologies were not determined and evaluations proximate to separation were essentially normal.  While the CI had symptoms, there was no pathology on which to base a higher rating than that adjudicated by the PEB.  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 right ear condition.

Vertigo.  According to the STR and MEB NARSUM, the CI’s vertigo (dizziness) began simultaneously with the right ear pain as noted above.  The panel noted testing was negative and no vertigo etiology had been determined at separation.

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the vertigo 10%, coded 6204 (peripheral vestibular disorders).  The VA did not service connect the vertigo, coded 6200, based on the C&P examination, citing no permanent residual or chronic disability was present.  The panel noted that although the CI had subjective complaints, examinations for the vertigo failed to show pathology or a diagnosis for the vertiginous symptoms.  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 vertigo.

BOARD FINDINGS:  In the matter of the right ear condition and IAW VASRD §4.87, the panel recommends no change in the PEB adjudication.  In the matter of the vertigo and IAW VASRD §4.87, 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 20170804, 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-2017-05742.

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