RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01954
BRANCH OF SERVICE:  Army 	BOARD DATE:  20140716
SEPARATION DATE:  20050331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (13F1P/Artillery Forward Observer) medically separated for asthma.  The asthma 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, mild and persistent,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “asthma, mild and persistent” as unfitting, rated 10%, with of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The PEB also wrote: “soldier takes Advair with Albuterol as needed.  Pharmacy records do not support the fact that soldier is compliant with medication regimen.” The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his 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; 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 20050121	VA - (1 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20050207	
Other X 0 (Not in Scope)	Other x 4	20050207	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050325 (most proximate to date of separation).

ANALYSIS SUMMARY:

Asthma.  The narrative summary (NARSUM) examination, 4 months prior to separation, notes the applicant had no history of breathing difficulties, and had a prior deployment to Afghanistan without symptoms.  His symptoms began while performing combat operations in Iraq.  The symptoms continued upon return to the United States, in April 2004.  He had shortness of breath (SOB) with exertion and in the middle of the night.  He had pulmonary function testing (PFT) that confirmed mild persistent asthma: results are summarized in the chart below.  The PFTs had therapeutic response to bronchodilator therapy, and provoked by methacholine challenge testing.  The CI was prescribed Albuterol (a bronchodilator rescue inhaler), Advair (a long acting inhaled bronchodilator combination with an inhaled steroid anti-inflammatory), and Singulair (a leukotriene blocker for bronchoconstriction and inflammation, tablets).  However, the CI continues to have persisting symptoms of SOB, experiencing wheezing during exercise and occasionally used Albuterol (as a rescue inhaler).  Physical examination was normal.  At the VA compensation and pension exam performed on 7 February 2005, a month prior to separation, the CI reported SOB after walking four city blocks, asthmatic attacks whenever he forgot to take his medications and that he required daily bronchodilator use.  He had no functional impairments, and no time lost from work due to asthma.  Examination of the lungs and heart were normal, chest X-ray was normal, and PFTs were normal and are summarized in chart below.  The PFTs 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 Function Test (PFT)	MEB ~9 Mo. Pre-Sep
(20040616)	VA ~ 1 Mo. Pre-Sep
(20050207)	
FEV1 (% Predicted)	63.6%	110%	
FEV1/FVC	102.5%	N/A	
Meds	At time of diagnosis.
27% FEV1 increased response to bronchodilator.	Post treatment since diagnosis and treatment with Albuterol, Advair, and Singulair.	
§4.97 Rating	30% (PEB 10%)	30%	

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 6602 (asthma, bronchial) used by the PEB for a 10% rating, and the VARD of 30%.  The Board found the diagnostic PFT met the higher rating criteria of 30% (FEV-1 of 56 to 70 percent predicted) measured at 63.6 % predicted.  Subsequent PFT were in the non-ratable ranges while on medications.  PFT at the VA after initiation of therapy with inhaled rescue bronchodilator and inhaled long acting bronchodilator combination with steroid anti-inflammatory medication (Advair), and anti-leukotriene oral medications, was much improved and normal.  The Board found the CI met the higher 30% evaluation due to “inhalational anti-inflammatory medication” (Advair) use at the time of separation as specified under code 6602.  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:  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 re-characterized 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 20131026, 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, AR20150007100 (PD201301954)

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