RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01775
BRANCH OF SERVICE:  Army	BOARD DATE:  20141031
SEPARATION DATE:  20041220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (68B/Aircraft Powerplant Repairer) medically separated for an asthma condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “asthma – post inflammatory” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition “multiple environmental allergies” for PEB adjudication.  The Informal PEB adjudicated combining “asthma and associated environmental allergies” as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The PEB also indicated that “this disability existed prior to service and was not permanently aggravated by service, but is compensable in accordance with 10 USC 1207a,” the 8 year rule.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Violation of profile?”

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:

Service IPEB – Dated 20041130	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma and Associated environmental Allergies	6602	0%	Respiratory Condition	6699-6600	NSC	20040909	
Other x 0  (Not in Scope)	Other x 0 	20040909	
Combined:  0%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20070719 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the CI’s assertion that there existed a “violation in his profile” during his career.  It is noted for the record that the Board has neither the jurisdiction nor authority to scrutinize or render opinions in reference to suspected improprieties in the disposition of a case.  The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.  The Board also acknowledged that a VA Compensation and Pension (C&P) examination was not contained in the case file and therefore, not in evidence before it.  It is not suspected that the missing evidence would significantly alter the Board’s recommendations.

Asthma Condition.  The STR revealed that the CI had no pre-existing pulmonary history.  While deployed, he developed respiratory symptoms which eventually were diagnosed as atypical pneumonia.  Despite initial treatment, he persisted with a severe cough and was referred to pulmonology.  After treatment with antibiotics and steroids, the CI underwent a pulmonary function test (PFT) with a methacholine challenge (definitive test for asthma) in July 2004.  The test revealed airway hyper-responsiveness to a degree of an atypical form of asthma, known as cough-variant asthma. At that time, the CI was taking Advair (inhalational steroid/  bronchodilator combination) and Flonase (nasal steroid) on a daily basis as well as nebulized Proventil (inhalational “non-steroid” bronchodilator [Albuterol]).  Albuterol inhaler was also used “as needed”/”rescue” medication for shortness of breath.

The narrative summary dated 9 September 2004 (3 months prior to service separation) summarized the history leading up to his current diagnosis and endorsed the inability to exercise due to an increase in symptoms. His physical examination revealed abnormal lower lung sounds and deep inspirations triggered fits of coughing (indicating irritating inflammation of lung tissue).  The diagnoses were asthma-post inflammatory and multiple environmental allergies.  Medications listed included, nebulized Albuterol, Budesonide (Pulmicort; an inhalational steroid), Allegra (allergy med), Fluticasone (Flonase; steroid nasal spray) and Advair (an inhalational steroid).  There was no prior emergent resuscitation or hospital admission for his respiratory condition.  The pharmacy authored medication profiles in evidence did not reflect any oral steroids dispensed.  The profiled primary diagnosis remained asthma.  The commander’s letter reflected that the CI’s medical condition of asthma would preclude him from further military service in a field situation.  Although absent any VA C&P examination, a subsequent VARD indicated not service-connected (NSC) for a respiratory condition noting “…fail to show any follow-ups for your respiratory symptoms.”

The Board directs attention to its rating recommendation based on the above evidence.  The unequivocal VASRD code for rating asthma is 6602 which is what the service utilized for a 0% rating, citing medication non-compliance.  Although the VA adjudicated the respiratory condition as NSC, its code was an analogous chronic bronchitis code of 6600.  Board members first agreed that despite the presence of normal PFT volumes, the degree of lung volume decrease on provocative testing meet the diagnostic criteria for asthma and therefore, agreed that code 6602 was more appropriate.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  This case is strictly dependent on the non-PFT derived criteria, which under 6602 are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; non-daily inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%.  The evidence was clear that the CI was receiving inhalational bronchodilators and thereby supporting 10% impairment.  Absent at least three courses of systemic corticosteroids, the 60% level was not applicable.  Board members deliberated if the CI’s condition supported the 30% criteria.  The MEB noted heavy use of medications to control his symptoms to include multiple inhalation anti-inflammatories as supported at the 30% level.  Although not capturing quantities necessary to sustain constant daily dosing, the Board discussed and agreed that it could not be assured that the military pharmacy was the sole source for dispensing 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 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, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  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	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130926, 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, AR20150007009 (PD201301775)

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