RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05827
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Attack Helicopter Repairer, medically separated from the Temporary Disability Retired List (TDRL) for “hypothyroidism status post total thyroidectomy” with a disability rating of 10%.

CI CONTENTION:  “Thyroid cancer changed to hypothyroidism, PTSD, hearing [damage and] ringing in ears.”  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 - 20081119	VARD - 20060712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hypothyroidism Status Post Total Thyroidectomy due to Thyroid Carcinoma	7903	10%	Hypothyroidism	7903	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Hypothyroidism.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a total thyroidectomy on 17 March 2005 and radioactive iodine ablation therapy.  Following this, he was treated with thyroid medication (Synthroid) and thyroid studies gradually returned to the normal range.  At the time of placement on the Temporary Disability Retired List (TDRL) the CI reported daily fatigue and required ongoing periodic monitoring for cancer recurrence.  The 27 June 2007 TDRL NARSUM, 18 months prior to TDRL removal, noted the CI’s chronic fatigue had improved.  There had been no cancer recurrence noted on periodic monitoring.  He had gained 150 pounds since his thyroid cancer diagnosis, but had recently lost 31 pounds.  Physical examination showed a well-healed surgical scar of the anterior neck.  The CI’s body mass index was 45 (normal less than 25) and the examination was otherwise normal.  On 22 June 2007, thyroid testing was normal.  The hypothyroidism condition was noted to be stable.  

The 1 October 2008 TDRL NARSUM, 3 months prior to separation, noted the CI’s hypothyroidism was stable, with thyroid studies within the normal range.  The examiner noted the CI was doing well and persistent fatigue “could be from a number of issues.”  Physical examination showed a decrease in BMI from 45 to 44 due to weight loss since the prior TDRL examination.  There were no other abnormal findings on examination pertinent to the CI’s hypothyroidism condition.  There was no sign of recurrence of the thyroid cancer and chronic fatigue had improved.  The hypothyroid condition was determined to be stable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hypothyroidism 10%, coded 7903 (hypothyroidism), citing ongoing fatigability and continuous medication required for control.  The VA rated the hypothyroidism 30%, coded 7903, based on the STR at the time of placement on TDRL (3 July 2006).  There was evidence to support a 10% rating for hypothyroidism, coded 7903 due to “fatigability, or; continuous medication for control.”  There was no evidence of “fatigability, constipation, and mental sluggishness” to support the next higher 30% rating.  The CI had gained a large amount of weight after his placement on TDRL; however, there was no evidence of muscular weakness or mental disturbance required to support the 60% rating.  Additionally at the time of the TDRL evaluations, recent weight loss was documented.  The panel also noted that the hypothyroidism was a direct consequence of thyroid cancer treatment and considered if rating as 7914 (malignant neoplasm, endocrine system) was warranted.  However, code 7914 specifies that a 100% rating is applicable for 6 months after cessation of treatment.  The CI was treated with thyroidectomy and radioactive ablation therapy shortly after his initial diagnosis.  Following that he was monitored periodically for more than 3 years without evidence of recurrence.  Therefore, at the time of permanent separation, the CI’s thyroid cancer was appropriately rated on the residuals due to the iatrogenic hypothyroidism.  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 hypothyroidism.  

BOARD FINDINGS:  In the matter of the hypothyroidism and IAW VASRD §4.119, 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 20170723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008251, 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