RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01084
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Cavalry Scout, medically separated for “asthma,” with a disability rating of 20%.

CI CONTENTION:  The CI contends for his unfitting asthma and PTSD/Depression/Anxiety.  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 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 PEB - 20080415	VARD - 20100914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma and Atypical Chest Pain	6699-6602	20%	Asthma	6602	0%	20080122	
Adjustment Disorder with Depressed Mood and Anxiety	Condition Does Not Constitute a Physical Disability	PTSD and Depression	9411	30%	UNK	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Asthma and Atypical Chest Pain.  The CI developed asthma and intermittent chest pain after an extended bout of pneumonia in February 2007.  He was extensively evaluated by Pulmonology, Cardiology, and Allergy.  A pulmonary function test (PFT) performed after the resolution of pneumonia (July 2007) revealed a low level FEV1 which was significantly improved with bronchodilator treatment.  He was diagnosed with asthma and remained medicated with daily inhaled corticosteroids and emergent inhaled bronchodilator as needed.  Serial PFT’s performed in August and October 2007 were normal.  At the Medical Evaluation Board (MEB) narrative summary (NARSUM) examination in December 2007 (8 months prior to separation), the CI endorsed increased symptoms of chest pain, shortness of breath (SOB), and wheezing when not taking his medication or when performing physical exertion.  He reported a constant baseline bilateral chest pain of 3/10 at rest and greater with activity.  The provider indicated a ‘pleuritic’ component to the CI’s chest pain.  The pain was assessed as ‘slight to moderate’ in severity and ‘constant’ in frequency.  His physical examination (PE) was cursory but normal.  Current use of medications included daily inhaled corticosteroids and bronchodilators as needed.  His diagnosis remained as asthma.  At the VA Compensation and Pension (C&P) examination on 22 January 2008, performed 7 months prior to separation, the CI reported a productive cough and SOB at rest, walking upstairs, or when lying flat.  Additionally, he endorsed monthly asthma attacks not requiring a physician visit.  With regards to the chest pain, the VA’s history attributed such symptoms to “…his respiratory condition” without further comment.  His PE and repeat PFT were normal with minimal change after bronchodilator therapy.  The VA did not render a chest pain related diagnosis because “…there is no pathology to render a diagnosis.”

The Board directed attention to its rating recommendation based on the above evidence.  Based solely on PFT parameters the CI’s condition on serial exams did not meet compensable disability criteria.  A compensable rating for asthma in this case must be predicated therefore on the non-PFT criteria under VASRD code 6602 (asthma).  There was no clinical evidence in support of the higher ratings of 60% or 100% under 6602.  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 near 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.  In reference to the PEBs notation of §4.96 (respiratory and pleural involvement), all members agreed that the overall severity of the asthma condition did not warrant an additional elevation of impairment rating.   

Board members then turned their attention to the atypical chest pain condition for rating purposes.  The VASRD clearly denotes that such a diagnosis is to be analogously coded as 5321 (Group XXI; muscle injuries) at either slight (0%), moderate (10%), or severe/moderately severe (20%) rating levels.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority agreed that the severity of the chest pain previously assessed as ‘slight to moderate’ explicitly supported no greater than the moderate 10% rating, coded 5399-5321. 

Contended PEB Conditions.  In regards to the adjustment disorder with depressed mood and anxiety, all Board members agreed that such a primary condition does not constitute a physical disability and therefore not ratable in the absence of an underlying ratable causative disorder as specified in the PEB’s referenced DoDI 1332.38.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the atypical chest pain condition, the Board majority recommends a disability rating of 10%, coded 5321 IAW VASRD §4.73.  The single voter for dissent recommended modification and did not elect to submit a minority opinion. There were no other conditions within the Board’s scope of review for consideration.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	
Atypical Chest Pain	5399-5321	10%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140302, 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 XXXXXXXXXXXXXXXXXX, AR20160006739 (PD201401084)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40% 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 40% 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:
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA