RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00557
BRANCH OF SERVICE:  Army	BOARD DATE:  20150212
SEPARATION DATE:  20050805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Human Resources Specialist) medically separated for an asthma condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “asthma, mild intermittent” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (chronic back pain) for PEB adjudication.  The Informal PEB adjudicated “asthma” as unfitting, rated 10%.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Prior to being diagnosed with asthma while on active duty, I was and avid runner and maintained a high level of physical fitness.  After being diagnosed, it was very difficult to continue to maintain the same level of physical fitness.  I was unable to run or exercise myself fully.  I continue to experience breathing problems directly related to my asthma.  I have had several ER visits to the VA Hospital due to asthma.  I was prescribed a nebulizer and associated medication to assist with the asthma, but I have to limit my physical activity as not aggravate the breathing condition.  Furthermore, I was not diagnosed until 3 yrs. into my enlistment and after my deployment to Bosnia.  Also, I suffered from episodes of bronchitis while on that 12 month deployment.”

SSCOPE 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 20050519	VA* - (~5  Mos. Pre - Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma with Bronchitis	6600-6602	30%	20050308	
Other x 1 (Not In Scope)	Other x 5 	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20050919 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:  

Asthma Condition.  The STR revealed the CI had no pre-existing pulmonary history.  She reported episodes of exercise induced dyspnea (difficult or labored breathing associated with activity) and chest tightness in early 2001.  Initially her condition was treated symptomatically with short course steroids and rescue inhalers.  In November 2001, she was referred to pulmonology for a diagnostic chemical respiratory test.  A methacholine challenge test was positive with a 27% decrease in FEV1, connoting a definitive diagnosis of asthma.  Her chest X-rays remained normal.  Pharmacy profiles and service file clinical documents indicated that she was taking both Proventil® (inhalational “non-steroid” bronchodilator [Albuterol]) as well as Advair (inhalational steroid/long-acting bronchodilator combination) on a daily basis.  Although having continued intermittent symptoms with activity, her serial pulmonary function tests (PFT) remained normal or non-specific.  Due to the inability to perform military duties, she was referred for an MEB.

The MEB narrative summary (NARSUM) of 22 March 2005 (4 months prior to separation), the CI reported episodic nighttime coughing and wheezing with exercise.  The physical examination was normal.  Asthma remained the sole diagnosis on her permanent profile and the commander’s statement noted her ability to perform duties assigned within her stated restrictions.  There was no C&P examination in the file, but a remote VARD of 19 September 2005 revealed a 30% rating for asthma based upon daily use of medication.

The Board directed its attention to its rating recommendation based on the above evidence.  Based solely on PFT parameters the CI’s condition did not meet compensable disability criteria.  Therefore, a compensable rating for asthma in this case must be predicated on the non-PFT criteria under VASRD code 6602 (asthma).  There was no evidence for respiratory failure, frequent exacerbations requiring physician intervention, daily use of high dose corticosteroids or immune-suppressive medications, or frequent use of systemic corticosteroids; therefore, the higher 60% or 100% ratings IAW 6602 criteria are not supported.  The treatment criteria underpinning the 10% and 30% ratings are the pivotal points for decision in this case.  The Board must make a critical judgment as to the requirement for daily use of medication at the time of separation.  The 10% rating requires “intermittent inhalational or oral bronchodilator therapy”; the 30% rating requires “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”

The NARSUM and clinical encounters within the STR coupled with pharmacy documents clearly established the CI’s ongoing use of an inhalational anti-inflammatory (Advair) near the time of separation, thus supporting the 30% criteria.  After considerable deliberation, Board consensus was that the presented evidence was insufficient to conclude that the CI did not require daily treatment with medications in order to maintain good respiratory control; and, therefore recommends 30% as a fair rating in this case.

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 re-characterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Asthma 	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140122w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		XXXXXXXXXXXXXXX     
		President 
		Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150011003 (PD201400557)

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			     XXXXXXXXXXXXXXX
				    Deputy Assistant Secretary of the Army
				          (Review Boards)
						
CF: 
(  ) DoD PDBR
(  ) DVA