RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1300234
BRANCH OF SERVICE:  Army	BOARD DATE:  20130702
DATE OF PLACEMENT ON TDRL:  20041130
Date of Permanent SEPARATION:  20060313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (21B/Combat Engineer) medically separated for asthma.  The CI first complained of exertional shortness of breath in 2003; he was diagnosed and treated for moderate persistent asthma for 2 years.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) or physical fitness standards.  He was therefore issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The lung condition, characterized as “persistent asthma,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (shrapnel wound to the right upper arm, which met retention standards) to the PEB.  The PEB adjudicated “asthma…” rated at 30% and placed the CI on the Temporary Retired Disability List (TDRL) in order for the condition to be stabilized by treatment.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was placed on the TDRL in November, 2004, where he continued to receive medical treatment.  A year later, in November 2005, the CI was re-evaluated and the asthma condition was found to have stabilized; a TDRL PEB in February 2006 re-adjudicated the case and judged the asthma condition at a permanent disability rating of 10% with no other conditions identified by the PEB.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application, but did list various conditions later rated by the VA in blocks 4 and 13 (information offered in support of the application), including the shrapnel wound to the right shoulder.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting asthma condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Final Service PEB - 20060225	VA (3 Mos.  After Adjudication Date*) - Effective 20041201	
On TDRL – 20041130	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
History of Asthma…	6602	30%	10%	Bronchial Asthma	6602	30%	20050524	
History of Shrapnel Wound to Right Upper Arm	Not Unfitting	Other x 7		
No Additional MEB/PEB Entries.			
Combined:  30% → 10%	Combined: 70%	
*Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation.

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Asthma.  The CI complained in November 2003 of a 1-2 month history of episodic shortness of breath (SOB) and chest tightness that increased with exertion and improved with rest; he had occasional expiratory wheezes on physical exam.  He received nebulizer treatment a month later for wheezing and was started on daily inhaled bronchodilator therapy (Albuterol).  An outpatient note in January 2004 reported pulmonary function test results showing mild restriction and obstruction.  He continued the daily albuterol therapy; the lung exam revealed diffuse expiratory wheezes.  An MEB physical exam in June 2004 noted a medication regimen consisting of a daily combined inhaled bronchodilator and anti-inflammatory medication (Advair: salmeterol and fluticasone), while continuing Albuterol daily and prior to physical training (PT).  At a pulmonary medicine exam the CI reported episodes of wheezing 3-4 times a day and nocturnal wheezing about four times a week.  He used Albuterol 3-4 times a day, sometimes 5-6 times a day.  He occasionally used extra inhalational fluticasone (Flovent) in addition to daily Advair.  The pulmonologist noted that the CI “has had multiple rounds of prednisone with some relief of [symptoms];” wheezing was present on the exam.  The narrative summary (NARSUM) in August 2004 (4 months prior to placement on TDRL) noted that the CI continued the regimen of Advair and Albuterol and was unable to complete the run portion of the PT test or to wear a gas mask.  The lung exam found minimal wheezing.  At the VA Compensation and Pension exam in May 2005 (6 months after TDRL placement) the CI reported 2-3 episodes per month each of daytime and nocturnal asthma requiring additional bronchodilator use.  He denied dyspnea on exertion.  His medications were daily Albuterol and a daily steroid inhaler (Flunisolide), which the examiner noted “showed some effectiveness.”  He had no interval hospitalizations or incapacitation due to asthma attacks since placement on TDRL.  The lung exam found no wheezing or other abnormalities.  A chest X-ray was reported normal.  At the TDRL re-evaluation in November 2005 (almost 4 months prior to permanent separation) the CI reported that his asthma was not significantly changed, and that he continued to “struggle” with aerobic activities such as running any distance or swimming; his most exertional activity was weight lifting.  His only asthma medication was Albuterol used as needed.  The examiner noted one urgent care visit but no hospitalizations for asthma during TDRL.  The lung exam revealed no wheezes.  The examiner re-prescribed daily Advair to the CI and directed him to continue albuterol as needed.  The pulmonary function evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Pulmonary Exam	MEB ~4 Mo. Pre-TDRL Entry	VA ~6 Mo. Post-TDRL Entry	MEB ~4 Mo. Pre-Permanent Sep	
FEV1 (% Predicted)	85	76	80	
FEV1/FVC	80%	81%	80%	
Meds	Salmeterol & fluticasone (daily);  albuterol, fluticasone (both prn)	Albuterol, flunisolide (both daily)	Albuterol prn	
§4.97 Rating	30%	30%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The Board concurred with the PEB and VA that, at the time of placement on TDRL, a 30% rating was appropriate based on “daily inhalational…bronchodilator therapy, or; inhalational anti-inflammatory medication.”  There was no documentation of monthly physician visits for care of exacerbations or prescribed courses of systemic corticosteroids to support the next higher 60% rating.  Next the Board turned its attention to a permanent rating at the time of removal from TDRL.  The PEB’s 10% adjudication was based on the CI’s report that only an inhaled bronchodilator was used on an as-needed basis; and despite a prescription for Advair being given by the NARSUM examiner, pharmacy records reportedly showed this was not filled by the CI.  Board members agreed that the FEV-1 and FEV-1/FVC, and the use of an Albuterol inhaler as needed, all met criteria for a 10% rating.  Board members concluded the preponderance of evidence regarding medication use indicated the CI was not using medications that met the guidelines for the 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends no change in the TDRL-entry rating of 30% and the 10% rating for the asthma condition at the time of permanent separation.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the asthma condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
		PERMANENT	
Asthma	6602	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130018160 (PD201300234)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA