RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01362
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20090505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Fire Controlman) medically separated by the Informal Physical Evaluation Board for “asthma” with a disability rating of 10%.   

CI CONTENTION:  “Asthma was more severe than rated.”  The applicant’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 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 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 PEB - 20081230	VARD – 20091009, 20100126 & 20121030	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	30%-20%	Asthma	6602	30%	20091217	
Allergic Rhinitis	Cat II	Allergic Rhinitis	6522	0%	20091217	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma Condition.  Although the CI had a history of childhood asthma, he experienced no symptoms after childhood until after entry into the Service.  Entry physical (MEPS dated 5 December 2003) documented no signs or symptoms of asthma or medication use.  In October 2007 he developed dyspnea (shortness of breath), wheezing, and cough with exercise.  Recurrent symptoms of wheezing, coughing, chest tightness, and dyspnea led to evaluation for possible asthma.  Although initial pulmonary function testing (PFT) was normal, provocation testing (methacholine challenge) confirmed the presence of reversible airway obstruction consistent with the diagnosis of asthma.  Inhaled bronchodilators (Proventil) were prescribed on an “as needed” basis and daily inhalational anti-inflammatories (Advair) were started in October 2007.  

According to the pulmonary evaluation on 3 October 2007 (19 months prior to separation) the examiner noted that the CI was using albuterol (inhalational bronchodilator).  The examiner stated that daily medications were required for asthma control, and instructed the CI to use Advair (inhalational anti-inflammatories) twice a day and Proventil (inhalational bronchodilator) every 4-6 hours as needed.  Pulmonary function testing (PFT) showed an FEV-1 of 106% of predicted and an FEV-1/FVC of 110% (normal).  The condition did not respond sufficiently to treatment and he was referred for a Medical Evaluation Board (MEB).  The MEB NARSUM evaluation, dated 14 November 2008 (6 months prior to separation), substantially agreed with the October 2007 pulmonary evaluation.  There were no new findings.  

According to the VA C&P evaluation on 17 December 2009 (7 months after separation) the examiner noted that the CI was using albuterol (inhalational bronchodilator) twice a week, along with Advair (inhalational anti-inflammatories), and Singulair (oral bronchodilator) every day.  PFT testing revealed no obstruction on spirometry with good bronchodilator response noted.  Decrease in vital capacity was also noted without specific values documented.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 30% (coded 6602), but reduced the rating by 20% to a final 10%, citing a reduction due to EPTS (Existed Prior to Service) factors (likely application of SECNAVINST 1850.4E rating guidance).  The VA initially rated the CI’s asthma as “not service connected” (NSC) as the CI failed to report for his scheduled VA examinations.  Following the VA exam on 17 December 2009, the VA initially rated the asthma at 0%.  A subsequent VARD dated 20121030 awarded a rating of 30%, coded 6602 effective back to the date of separation citing a “clear and unmistakable error” based on the VA exam from December 2009 and citing medication usage.  It was agreed that “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” was not evident in the available STR.  Therefore, a 60% rating was not warranted.  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members considered that the exams in evidence reported current prescription use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, as noted by the pulmonary and VA examiners, as well as the PEB.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication use.  There was no diagnosis of asthma or use of any asthma medications on Service entry; therefore, the Board agreed that any asthma rating on entry would either be 0% or indeterminable, and no EPTS deduction was warranted.  

There was no performance based evidence from the record that allergic rhinitis significantly interfered with satisfactory duty performance.  There were no significant polyps or nasal passage obstructions over 50% noted in the record.  The Board concluded therefore that this condition could not be recommended for additional disability rating; however, any contribution of allergic rhinitis to the CI’s unfitting asthma condition was considered in the asthma rating below.  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, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97 with no EPTS deduction.  In the matter of the allergic rhinitis condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 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 20140317, 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 15 Apr 16 ICO XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 09 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXX 
	(i) PDBR ltr dtd 14 Apr 16 ICO XXXXXXXXXXXXXXXXXX

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

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

     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

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

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

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.

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

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 
     
     i. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 70 percent disability rating (increased from 10 percent) effect date of discharge.
 
     j. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect 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.

		XXXXXXXXXXXXXXXXXX
		Assistant General Counsel
		(Manpower & Reserve Affairs)