RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00215		
BRANCH OF SERVICE:  MARINE CORPS	Separation Date:  20060315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6, Motor Transport Operations Chief, medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “asthma” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded three other condition(s) (perennial allergic rhinitis, food allergy, shellfish, and tobacco abuse) for PEB adjudication.  The Informal PEB adjudicated “asthma” as unfitting, rated 10%.  The remaining conditions were determined to be Category II “perennial allergic rhinitis” (contributing to the unfitting condition); and Category IV “food allergy, shellfish,” and “tobacco abuse” (conditions which do not constitute a physical disability.)  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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB – Dated 20051221	VA* - (~9 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20061208	
Perennial Allergic Rhinitis	Cat II	Not Addressed	
Food Allergy, Shellfish	Cat IV	Not Addressed	
Tobacco Abuse	Cat IV	Not Addressed	
Other x 0 (Not In Scope)	Other x 2 	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070127 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Asthma Condition.  The CI developed initial symptoms of chest tightness and thick sputum with exertion or during cold weather in 1999 that was treated with an albuterol inhaler.  In 2004 the CI could not perform his Physical Fitness Test due to chest tightness, shortness of breath and difficulty breathing on exertion.  The Pulmonologist in July 2004 documented persistent difficulty breathing, wheezing and chest tightness that occurred with exercise and exposure to cold weather.  The symptoms occurred two to three times per week.  A Pulmonary Function Test (PFT) done at this visit demonstrated a mild obstruction and a Methacholine test was positive for asthma.  The CI was started on Advair (inhalational anti-inflammatory and bronchodilator medication - fluticasone/salmeterol) twice daily in addition to the albuterol inhaler (bronchodilator) as needed.  In November 2004, the CI had worsening of his symptoms and the Advair dose was increased and Singulair 10mg (leukotriene receptor against) daily was added to the treatment regimen.  In April 2005, the CI continued to report cough, wheezing, chest tightness and shortness of breath despite being on optimal treatment and the examiner diagnosed severe persistent extrinsic asthma.  

The MEB Narrative Summary (NARSUM) exam approximately 5 months prior to separation documented that the CI had persistent asthma symptoms and was compliant with all of his medications including Advair inhaler, Albuterol inhaler, Allegra, Singulair and Spiriva (anticholinergic inhaler).  The lung exam was normal and there were no wheezes noted.  The PFT results are noted in the chart below.  

The VA Compensation and Pension (C&P) exam approximately 9 months after separation documented that the CI would have asthmatic attacks if he forgot to take a dose of the Advair inhaler.  He was asymptomatic on medication unless he exercised.  There was no indication in the notes that the CI was noncompliant with his current treatment regimen.  The PFT results are noted in the chart below.

The PFT 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 ~5 Mo. Pre-Sep	VA C&P ~9 Mo. Post-Sep	
FEV1 (% Predicted)	88	97	
FEV1/FVC	71	85	
Meds	Advair BID; albuterol inhaler as needed; Spiriva and Allegra QD; Entex as needed	Advair BID; albuterol as needed	
§4.97 Rating	30% (PEB 10%)	30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the Asthma condition as 6602 (asthma) and rated at 10%.  The VA used the same coding and rated at 30%.  No PFT exams would have rated greater than 10% (FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent).  There was no evidence that the CI met the 60% rating criteria of “at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids.”  The Board therefore reviewed the 10% rating criteria of “… intermittent inhalational or oral bronchodilator therapy” versus the 30% rating criteria of “… daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  The Board agreed that the 30% rating criteria was met based on the documented use of inhalational anti-inflammatory medication (Advair) on both the Service and VA exams, as well as the remainder of the record.  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 IAW §4.100.  

Contended PEB Conditions (Perennial Allergic Rhinitis, Food Allergy, Shellfish and “Tobacco Abuse.  The PEB adjudicated the perennial allergic rhinitis contended condition as a Category II condition (“Conditions that contribute to the unfitting condition“).  The Board’s first charge with respect to this condition is an assessment of the appropriateness of the PEB’s fitness adjudications.  The allergic rhinitis condition was noted on the LIMDU and any overlap with asthma symptoms was considered in the asthma rating above.  There were no noted upper airway obstructions and insufficient evidence that allergic rhinitis rose to the level of being unfitting and separately compensable.  

The PEB also adjudicated the “Food Allergy, Shellfish” and “Tobacco Abuse” contended conditions as Category IV conditions which do not constitute a physical disability.  IAW DoDI 1332.38 the CI’s food allergy and tobacco use conditions are not physical disability conditions and are not compensable.  

After due deliberation in consideration of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudications for the perennial allergic rhinitis, food allergy and tobacco abuse contended conditions; and, therefore, no additional disability ratings can be recommended.  

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.  As discussed above, PEB reliance on SECNAVINST 1850.4E for rating was operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100a.  In the matter of the perennial allergic rhinitis, food allergy, shellfish and tobacco abuse contended conditions; the board unanimously recommends no change from the PEB determinations.  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 20131218 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 16 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 16 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 11 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 31 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 31 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 31 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 30 Nov 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 30 Nov 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 01 Dec 15 ICO  XXXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 04 Jan 16 ICO  XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (k) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List effective date of discharge with a 60 percent (increased from 20 percent) disability rating.

     b. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List effective date of discharge with a 50 percent (increased from 10 percent) disability rating.

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List effective date of discharge with a 40 percent (increased from 10 percent) disability rating. 

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List effective date of discharge with a 30 percent (increased from 10 percent) disability rating. 

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List effective date of discharge with a 50 percent (increased from 20 percent) disability rating. 

     i. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List effective date of discharge with a 30 percent (increased from 20 percent) disability rating. 

     j. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.  
       
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.