RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00281
BRANCH OF SERVICE:  Army	BOARD DATE:  20150526
Separation Date:  20060902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Cannoneer) medically separated for asthma condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for an Medical Evaluation Board (MEB).  Asthma was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated asthma as unfitting, rated 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Asthma”

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:

Service IPEB – Dated 60703	VA* - (~15 Days Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	30%	20060818	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070411 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma.  The CI had onset of respiratory symptoms in September 2000 that required a Prednisone burst (course of systemic corticosteroids) and he was later placed on an Albuterol inhaler (bronchodilator) for asthma.  He required steroid bursts in December 2000 and June 2004 and had been hospitalized in May 2001 and in 2005.  Medications of inhaled Advair (anti-inflammatory and bronchodilator combination) and oral Claritin had been added prior to his 2005 hospitalization.  In the year prior to the MEB narrative summary (NARSUM) evaluation he had not required treatment for an acute asthma exacerbation, and had not been hospitalized.

The MEB NARSUM exam 3 months prior to separation documented that smoke was a significant trigger for the CI’s asthma as well as very prolonged exposure to very dusty environments.  Chest X-ray and lung exam were normal.  The CI required Albuterol rescue inhaler two to three times each day in May and June, but required no Albuterol rescue the rest of the year.  The MEB NARSUM pulmonary function testing (PFT) findings are summarized in the chart below.  The CI had an asthma exacerbation in August 2006 (a month prior to separation) with wheezing and required systemic steroids and was started on inhaled steroids (Fluticasone) with resolution of symptoms.

The VA Compensation and Pension (C&P) exam is missing from the evidence, however, the VARD on 11 April 2007  noted that the VA C&P exam on 18 August 2006, approximately 15 days prior to separation documented an FEV1/FVC of 65% and an FEV1 of 65%.  The VA C&P PFT findings are summarized in the chart below.

Pulmonary Exam	NARSUM ~3 Mo. Pre-Sep	VA C&P ~15 day Pre-Sep	
FEV1 (% Predicted)	59	65	
FEV1/FVC	65	65	
Meds	Not cited	Not cited	
§4.97 Rating	30% (PEB 0%)	VA 30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 and rated at 0%.  The VA used the same coding as the PEB and rated at 30%.  IAW VASRD §4.97, asthma is rated on either PFT results (FEV-1 or FEV-1/FVC percent predicted) or medication use.  The PEB cited medication use for their 0% rating, and the VA cited PFT results for their 30% rating.  The CI’s medication use of intermittent inhalational bronchodilator therapy (Albuterol) would warrant a 10% rating; however, rating under PFT criteria on evaluations performed proximate to separation would rate at 30%.  Both the PFT’s performed for the MEB exam and the C&P exam demonstrated the FEV1 and FEV1/FVC to both be less than 70% predicted and met the 30% rating criteria of FEV-1 of 56-70% predicted or FEV-1/FVC of 56-70%.  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 §4.97.

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 could not determine what rating source the PEB applied (AR635-40, DODI 1332.39, or other) for rating the asthma condition and the asthma was adjudicated IAW VASRD criteria only by this Board.  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%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140103, 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 XXXXXXXXXXXXXXXXXXXX, AR20150014177 (PD201400281)

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