RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01421
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an, E4, Operations Specialist, medically separated for “asthma,” with a disability rating of 10%.

CI CONTENTION:  The applicant makes no specific contention in their application but provided a detailed list of dates and treatments for her asthma.  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 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 - 20050922	VARD - 20070226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bronchial Asthma	6602	10%	Asthma	6602	10%	20070201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bronchial Asthma.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in September 2004.  Inhaled anti-inflammatory (Advair), inhaled bronchodilators (Albuterol), and oral bronchodilator (Singular) were prescribed on a “twice a day” basis in September 2004.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “unspecified asthma, without mention of status asthmaticus” for PEB adjudication.
At the MEB NARSUM examination dated 16 August 2005, 5 months prior to separation, the CI reported taking an inhaled bronchodilator (albuterol) on an as needed basis for intermittent exertional wheezing and shortness of breath.  Her MEB respiratory focused physical examination (PE) was normal.  A clinical encounter dated 29 September 2005 (3 months prior to separation) indicated that the CI was taking an inhaled non-steroid anti-inflammatory medication of Tilade (nedocromil sodium) which brought her asthma under control.  At the VA Compensation and Pension (C&P) evaluation dated 1 February 2007, 13 months after separation, the CI voiced occasional episodes of exertional shortness of breath and weekly episodes of wheezing.  Her current medication was intermittent use of the inhaled bronchodilator.  Her PE was normal.  Additionally noted was that the CI was pregnant and did not want any prescription medications.  The nearest to separation pulmonary function test that was in the case file was dated approximately 13 months after separation that revealed an FEV1 of 90 and an FEV1/FVC of 76.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the asthma condition at 10% under VASRD code 6602 (bronchial asthma).  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  The non-PFT derived criteria under 6602 are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; non-daily inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%.  

Absent evidence of oral corticosteroid use (60% rating), Board members deliberated if the CI’s condition supported either the 10% or 30% impairment rating.  From an objective PFT standpoint, the only documented PFT closest to the CI’s date of separation (13 months post separation) did not support greater than a 10% impairment rating based upon an FEV1/FVC between 71 and 80 percent.  However, closer to separation, the STR clearly noted the CI using the inhalation medication of Tilade.  All Board members agreed that the Tilade medication (although not a steroid) is officially FDA classified as an anti-inflammatory and therefore meets the 30% impairment criteria of ‘use of an inhalational anti-inflammatory medication’.  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.  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	
Bronchial Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140319, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

EMORANDUM 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 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX

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

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.

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

     d. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective 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.

						XXXXXXXXXXXXXXXXXXXX
						Assistant General Counsel
						(Manpower & Reserve Affairs)