RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01507
BRANCH OF SERVICE:  Army 	
DATE OF PLACEMENT ONTO TDRL:  20060412	DATE OF REMOVAL FROM TDRL:  20070618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Automated Logistical Specialist) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “exercise-induced asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (migraine headaches) for PEB adjudication.  The Informal PEB (IPEB) adjudicated his asthma as unfitting, rated 30%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals and was placed on Temporary Disability Retired List (TDRL).  Approximately 12 months later, the IPEB adjudicated the asthma condition as unfitting, rated 10% citing application of the VASRD.  The CI appealed to the Formal PEB (FPEB), which affirmed the PEB findings and rating, and was medically separated. 

CI CONTENTION:  The applicant contends that there has been no improvement in his asthma condition since it was first rated and it should be rated at 30%.  His complete submission is at Exhibit A.

SCOPE 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 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 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:  

Final PEB – 20070613	VA Rating Decision1 - 20060609	
TDRL Placement – 20060412	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Asthma	6602	30%	10%	Asthma	6602	30%	30%	
Other x 1 (Not in Scope)	Other x 7	
RATING:  30% → 10%	RATING:  30%	
1. Most proximate to TDRL Placement
2. Rating derived from C&P exam dated 20060502, ~1 month post-TDRL placement
3. Rating derived from C&P exam dated 20060502, ~14 mos. pre-TDRL removal 

ANALYSIS SUMMARY:  

Asthma Condition.  In April 2005, the CI had pulmonary function testing (PFT) coupled with a methacholine challenge test that was positive, indicating the diagnosis of asthma.  His symptoms of shortness of breath (SOB), wheezing, and cough worsened with running, exercise, or exposure to cold temperatures.  Initially treated with profiled restrictions and “pre-exercise” use of Proventil® (inhalational “non-steroid” bronchodilator [Albuterol]), daily use of Flovent® (inhalational steroid) and Advair™ (inhalational steroid/bronchodilator combination) were added due to persistent symptoms with increased activities.  He was permanently profiled in January 2006 with a diagnosis of exercise induced asthma.  At the MEB narrative summary (NARSUM) examination performed on 10 January 2006 (3 months pre-TDRL placement), the CI reported the inability to wear his chemical protective mask because of increased SOB.  He endorsed similar symptoms upon maneuvering stairs or after 1-2 minutes of running.  His physical examination (PE) and radiographic evaluation was normal.  The service treatment record revealed no history of hospital admissions or courses of systemic steroids.  

At the VA Compensation and Pension (C&P) evaluation performed on 2 May 2006 (a month post-TDRL placement), the CI reported very infrequent asthma-like symptoms which improved with an “as needed” use of a bronchodilator.  His medication use did not include the use of steroids.  His PE remained normal.

The TDRL re-evaluation performed on 26 March 2007 (3 months preceding the CI’s permanent separation) noted the continued absence of inhaled corticosteroids.  He endorsed improvement in overall respiratory symptoms when using a pre-exercise non-steroidal medication as well as an “as needed” rescue bronchodilator.  His PE was normal and his diagnosis remained exercise induced asthma.  The examiner described the CI’s condition as “stable for final rating.”  The PFT evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Pulmonary Exam	MEB ~8 Mo. Pre-
TDRL Placement
(20050804) 	VA C&P ~1 Mo. Post-
TDRL Placement
(20060502) 	MEB ~3 Mo. Pre-
TDRL Removal
(20070326) 	
FEV1 (% Predicted)	98	102	97	
FEV1/FVC	68 	71	82	
Meds	Advair 	-	bronchodilator	
§4.97 Rating	30%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition under the unequivocal asthma VASRD code of 6602 at 30% being placed on TDRL citing daily medication use and 10% at removal from TDRL and permanent separation citing intermittent bronchodilator use.  The VA utilized the same code and maintained a 30% rating citing “daily inhalational therapy.”  The PEB’s TDRL rating was IAW VASRD §4.97 which defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  The non-PFT 6602 criteria 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 courses of systemic (oral or parenteral) corticosteroids” for 60%.  The record did not reflect that the CI was ever placed on corticosteroids; therefore, Board members agreed that no criteria greater than the 30% level was exceeded upon TDRL placement.  With regards to a permanent rating recommendation, all Board members agreed that the 60% rating level was again not applicable.  The TDRL NARSUM clearly revealed the CI with a normal PFT and the discontinuance of inhalational steroid medication which did not support above a 10% level of impairment.  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 adjudication for the asthma condition either upon TDRL placement or upon TDRL removal and permanent separation.    

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 and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication for the period of temporary retirement and/or permanent separation.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability at either temporary retirement or permanent separation.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140331, 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, AR20160003128 (PD201401507)

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