RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00910
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20061101	DATE REMOVED FROM TDRL:  20080117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “constrictive bronchiolitis,” with a 10% disability rating.

CI CONTENTION:  His initial diagnosis for constrictive bronchiolitis has caused him heart problems, heart attack, and ischemia.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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 PEB – 20060818/20071108	VARD - 20061211	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Constrictive Bronchiolitis	6699-6602	30%	10%	Constrictive and Obliterative Bronchiolitis	6699-6602	NSC	NSC	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY 

Constrictive Bronchiolitis.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s respiratory condition began post-deployment in March 2005 after being exposed to multiple oil fires.  Diagnostic imaging studies as well as a lung biopsy eventually revealed pulmonary scarring with anthracosis (accumulation of carbon/inflammation in the lungs).  Despite medication, his adverse pulmonary symptoms remained to the point where he could not fulfill his military physical requirements.  Although the overall respiratory condition proved to be a diagnostic challenge in that various conditions (to include asthma and chronic obstructive pulmonary disease) were considered and listed as the underlying or primary pathology, the MEB eventually forwarded “bronchiolitis obliterans constrictive with reversible obstruction,” for PEB adjudication.  The MEB NARSUM examination on 11 July 2006, leading to TDRL placement, did not document any new or additional physical symptoms.  The respiratory focused physical examination (PE) was normal.  His medications included Advair (inhaled corticosteroid) and Albuterol (inhaled bronchodilator) use on a daily basis.  The diagnosis remained unchanged from the MEB’s initial submission.  On 1 November 2006, the CI was placed on the TDRL at 30% impairment according to VASRD rating guidelines citing FEV1 of 69%.  At the TDRL re-evaluation examination performed on 19 October 2007, 13 months after TDRL placement, the CI reported “some shortness of breath on extreme exertion”.  He was on no medications and his PE was normal.  Repeat spirometry in 19 October 2007 revealed an FEV1 of 71% and an FEV1/FVC of 78%.  The corresponding IPEB on 15 January 2008 permanently separated the CI at 10% impairment citing spirometry FEV1 parameters.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same analogous primary VASRD code of 6602 (asthma) and rated 30% upon TDRL placement by the PEB and “not service connected” by the VA whereby the condition was bundled with a secondary respiratory condition.  Board members first agreed that the presented evidence did not support a rating higher than the 30% at TDRL placement noting FEV1 spirometry parameters.  Board members then focused their attention on finding evidence for a §4.97 rating higher than the 10% permanent rating adjudicated by the PEB at TDRL removal.  Although the TDRL re-evaluation spirometry parameters were minimally improved from prior studies, all Board members agreed that such improvement still supported a 10% impairment rating.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s permanent 10% rating upon TDRL removal.  

BOARD FINDINGS:  In the matter of the constrictive bronchiolitis condition, the Board unanimously recommends no change in the PEB’s adjudication upon TDRL placement as well as at permanent retirement.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.    

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140216, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160010339 (PD201400910)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review
(DoD PDBR) recommendation and record of proceedings pertaining to the subject
individual. Under the authority of Title 10, United States Code, section 1554a, I accept
the Board's recommendation and hereby deny the individual's application.

This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA