RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE: PD-2020-00014 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20051125

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Corpsman, medically separated for “functional vocal cord dysfunction [VCD]” with a disability rating of 10%.

CI CONTENTION: In addition to the vocal cord and insomnia conditions, review requested of an additional condition (GERD) not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20050929	VARD – 20060216 & DRO 20070507*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Functional VCD	8299-8210	10%	VCD	6599-6516	10%	20051129
20051207	
Insomnia	Category II	Insomnia*	9499-6354	10%	20051129	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%*	
*Initially combined with VCD, separated as above in 2007 (retroactively) by Decision Review Officer

ANALYSIS SUMMARY:

Functional Vocal Cord Dysfunction. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s vocal cord condition initially manifested as “some squeaky noises” during both inspiration and expiration, but exercise testing and pulmonary broncho-challenge tests were negative (no reactive airway disease/asthma). Speech therapy provided some relief, but daily stridor symptoms continued, and the CI was unable to exercise other than walking at a moderately pace, and noisy respiratory cycle interfered with duty. The 16 February 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of inspiratory strider with marked squeaking that interrupted sleep. Physical examination showed inspiratory transmitted sounds without pulmonary wheezing. A chest X-ray was normal, and a specialist consult documented paradoxical vocal cord functioning. During the 26 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI

reported VCD and the inability to perform sports since 2004. Physical examination revealed high pitched noises with each breath.

At the 29 November 2005 VA Compensation and Pension (C&P) general examination, 4 days after separation, the CI stated that the inspiratory squeak had resolved but she continued to experience dyspnea (shortness of breath) on exertion and general fatigue. Physical findings showed  lungs  clear  to  auscultation  bilaterally  without  wheezes  or  crackles.    During   the   7 December 2005 C&P ear, nose and throat (ENT) examination, the CI reported three symptomatic episodes of VCD, with the last 7-month episode ending in November 2005. The examiner found a well-healed transverse surgical scar along the right anterior neck (prior lymph node removal), and direct laryngoscopy showed slight hyperemia of the mucosa overlying the right arytenoids (larynx). The vocal folds appeared normal, as did the remainder of the larynx and hypopharynx. Diagnoses included VCD (by history) and laryngitis.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the VCD 10%, analogously coded 8299-8210 (tenth (pneumogastric, vagus) cranial nerve paralysis), and also listed “insomnia” as a Category II condition which will be addressed below. The VA rated the VCD 10%, analogously coded 6599-6516 (laryngitis, chronic), based on the C&P general examination, citing intermittent inspiratory squeak and persistent dyspnea on exertion and insomnia. The VA also rated the insomnia 10% coded 9499-6354 (chronic fatigue syndrome) based on the C&P and STR examinations citing problems with fatigue and continuous use of Ambien to control insomnia. There was insufficient evidence of incomplete severe paralysis of the tenth cranial nerve for the next higher rating under code 8210, when considering the extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart. There was no thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy for any higher alternative rating under code 6516. 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 vocal cord condition.

Contended PEB Condition: Insomnia. As noted above, the PEB listed the insomnia as a related Category II diagnosis. The panel’s first charge was to assess whether the condition was reasonably justified as separately unfitting for rating consideration. A limited duty form was not in evidence, and the non-medical assessment (NMA), 2 months before separation, documented the CI “does not feel well due to not being able to sleep at night” due to the VCD and “voice fatigues easily when talking and at times has to repeat her statements to be heard.” The MEB NARSUM noted excessive daytime somnolence and the examiner’s diagnosis included insomnia, not otherwise specified. The STR indicated a sleep study was performed and there was no obstructive sleep apnea to account for the insomnia, and multiple medications had been used with some symptom decrease. “Other insomnia,” was forward to the PEB on the NAVMED 6000/1 (MEB form). Panel members agreed that the insomnia was reasonably justified as separately unfitting given the multiple medications as well as evidence from the MEB examinations and NMA. There was no obstructive sleep apnea or evidence of nearly constant significant symptoms or periods of greater than one week of incapacitation, and symptoms waxed and waned and were fairly well-controlled by medication. Thus, a 10% rating was warranted under code 9499-6354. After due deliberation, considering all the evidence, the panel recommends a separately unfit determination with a disability rating of 10% for the insomnia, coded 9499-6354.

BOARD FINDINGS: In the matter of the vocal cord condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended insomnia, the panel agrees it was reasonably unfitting and recommends a disability rating of 10%, coded 9499-

6354 IAW VASRD §4.88b. 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Functional Vocal Cord Dysfunction	8299-8210	10%	
Insomnia	9499-6354	10%	
	COMBINED	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:
Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 30 Jun 20
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEE) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.
1.