RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01354
BRANCH OF SERVICE:  Army	BOARD DATE:  20141125
Separation Date:  20040421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve SSG/E-6 (92A/Automated Logistics Specialist) medically separated for asthma.  The asthma could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his profile indicated he could do an alternate event for his physical fitness test.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “mild persistent asthma,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB (IPEB) adjudicated “mild persistent asthma” as unfitting, rated 10%, with application of the Veteran Affairs Schedule for Rating Disabilities (VASRD).  The CI non-concurred with the IPEB findings but did not submit a written appeal.  A review by the US Army Physical Disability Agency reaffirmed the IPEB’s findings and the CI was medically separated.

CI CONTENTION:  The CI writes: “I feel my asthma condition warranted a higher rating at the time of discharge.”

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; and, 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:

Service IPEB – Dated 20040308	VA - (9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Persistent Asthma	6602	10%	Exercise Induced Asthma	6602	10%	20050107	
Other x0	Other x3	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050217 (most proximate to date of separation)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation.

Mild Persistent Asthma Condition.  The CI developed symptoms of recurrent shortness of breath (SOB) with exertion and intermittent heart palpitations.  He underwent a cardiac workup for the heart murmur which revealed a flow murmur.  The physician considered asthma as part of his differential diagnosis because of the SOB and exertional dyspnea.  The CI underwent a methacholine challenge test which was positive for asthma as the test demonstrated a greater than 20% drop in lung function.  The internal medicine specialist diagnosed mild asthma and started the CI on an Albuterol inhaler to use as needed and before exercising; and also prescribed Flovent (steroid inhaler) one puff twice daily; he was doing fairly well with his asthma condition under control.  .  The CI was seen in the emergency room on 13 August 2003, for SOB, chest tightness with physical activity, ultimately the CI was given a permanent P3 profile for asthma.  The commander’s statement indicated that the CI’s physical condition created a burden for him and impacted readiness and he was unable to serve in any combat environment.  The CI was reevaluated by the Internal Medicine Specialist for increased SOB with exercise.  The examiner noted that the CI was only using the Flovent 5 out of 7 days per week.  The examiner stopped the Flovent and started Advair 500/50 twice daily (inhalational anti-inflammatory drug).  The MEB narrative summary exam (approximately 5 months prior to separation), documented that the CI was using his Advair inhaler twice daily and Albuterol inhaler as needed.  The chest exam revealed breath sounds that were bilateral and symmetrical, without any wheezing.  The examiner diagnosed mild persistent asthma.  During the VA Compensation and Pension exam (approximately 9 months after separation), the examiner documented that the CI required his Albuterol inhaler 2 months prior to this exam when he was running.  The physical exam findings revealed that the lungs were clear bilaterally without wheezes.  A pulmonary function test demonstrated a non-compensable result interpreted as “a minimal obstructive defect.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the mild persistent asthma as 6602 (asthma) and rated at 10%.  The VA used coded 6602 (asthma), for exercise induced asthma, rated at 10%.  The CI was started on Advair 500/50 twice daily in October 2003.  At the time of the MEB exam, the CI was using the Advair as prescribed.  The Board agreed that the CI met the 30% criteria of daily inhalational anti-inflammatory medication.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the mild persistent asthma condition.

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 mild persistent asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Mild Persistent Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150006337 (PD201301354)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     
						
CF: 
(  ) DoD PDBR
(  ) DVA