RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01574
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141113
SEPARATION DATE:  20041118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty MM3/E-4 (MM3/Machinist Mate) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of her Rating or satisfy physical fitness standards.   She was referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “asthma, exercised induced” and “other acute and subacute respiratory conditions due to fumes and vapors” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “asthma” as unfitting, rated 10% with application of the VA Schedule for Rating Disabilities (VASRD).  The PEB did not address the second MEB condition of “other acute and subacute respiratory conditions due to fumes and vapors.”  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 condition 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 Naval Records.  

RATING COMPARISON:

Service  IPEB – Dated 20041007	VA* - (~8.5 Months Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050802	
Other x 0  (Not in Scope)	Other x 3	
Rating:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20051108 (most proximate to date of separation)

ANALYSIS SUMMARY:

Asthma .  The narrative summary (NARSUM) noted the CI had reported shortness of breath (SOB) multiple times while a student in training.  The SOB resolved.  Several months later, she experienced two episodes of dyspnea; one was precipitated by exposure to cigarette smoke during a cab ride.  The CI indicated there was poor ventilation in the cab.  The CI was evaluated by medical, and wheezing was the single finding.  She was returned to duty.  Available treatment records documented the first presentation of asthma occurred in September 2003.  At that time the CI underwent pulmonary function studies that were normal (FVC& FEV1 were >100%); however, she had a positive methacholine challenge test, consistent with asthma.  There was no evidence of acute exacerbation requiring hospitalization, or frequent visits to the emergency room for asthma attack.  There was no history of respiratory infections or respiratory failure.  The CI was placed on daily inhalational therapy and had a rescue inhaler that was prescribed on as needed basis.  However, she continued to have exacerbation secondary to exposure to chemicals in her work environment, exposure to second hand smoke and exercise.  Medications were not effective.  The CI was advised to avoid activities and environments that exacerbated her condition and was recommended for an MEB.  

The MEB NARSUM dated 1 September 2004, recorded at the time of the MEB; the CI used only the “rescue” (quick acting to terminate SOB or prevent SOB) inhaler on as needed basis.  She was noted to have done well with minimal exacerbation of her symptoms so long as she avoided field day activities, smoke and exercise.  Physical examination of the lungs was normal.  The physician recommended the continued use of the rescue inhaler as needed and avoidance of triggers.  Prognosis was recorded as good, provided she avoided triggers.  The diagnosis of asthma, mild intermittent was assessed.  The LIMDU recorded at the NARSUM indicated the CI must be stationed near a facility that could treat her asthma, and that she needed to refrain from any significant exertion.

At the VA Compensation and Pension examination (approximately 8 months after separation), the CI reported occasional SOB at night, SOB after walking six city blocks or less and had approximately four asthma attacks per month.  She noted she used daily inhaler and a rescue inhaler.  She reportedly stated she lost one day of work per week due to her asthma condition.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the condition at 10% under the 6602 code.  The VA granted a 10% evaluation based on the pulmonary function tests (PFTs).  An evaluation of 10% is granted whenever there is forced expiratory volume in one second (FEV-1) of 71 to 80% of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 71 to 80%; or intermittent inhalational or oral bronchodilator therapy.  A higher evaluation of 30% is warranted if there is FEV-1 of 56 to 70% predicted; or FEV-IIFVC of 56 to 70%; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.”

The Board noted the NARSUM documented only intermittent use of a rescue bronchodilator inhaler.  The PFTs were consistent with the 10% rating.  The Board agreed that 10% was supportable by the pulmonary function evidence at hand and the use of intermittent “rescue” bronchodilator inhalation therapy; however, the 30% rating was not approached.  Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the 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 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 re-characterization of the CI’s disability and separation determination.

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

		

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 8 Apr 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN