RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01654
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20050923

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) an active duty, E-4, Chinook Mechanic, medically separated “mild persistent asthma” with a disability rating of 10%.

CI CONTENTION:  The CI offers no specific contention, but lists the words “asthma” and “back”.  His 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 - 20050811	VARD - 20060819	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Persistent Asthma	6602	10%	Asthma	6602	30%	20060802	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with asthma in late 2003.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “asthma, mild persistent” for Physical Evaluation Board (PEB) adjudication.

As confirmed by a medication profile, the contemporaneous STR during the time leading up to separation and the NARSUM examiner, the CI had active prescriptions for an inhaled bronchodilator (Albuterol) to be used as needed, and an anti-inflammatory medication (Advair), to be inhaled twice per day (among other prescriptions).

The pulmonary function evaluations (PFT’s) in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Pulmonary Exam	MEB ~9 Mos. Pre-Sep	Pulm ~2 Mos. Pre-Sep	VA C&P ~10 Mos. Post-Sep	
FEV1 (% Predicted)	115	100	94	
FEV1/FVC	86%	86%	80%	
Meds	Inhaled anti-inflammatory	Inhaled anti-inflammatory 	Inhaled anti-inflammatory	
§4.97 Rating	30%*	30%*	30%*	
	*On the basis of inhaled anti-inflammatory use

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% coded 6602(asthma, bronchial), citing intermittent use of inhaled steroids.  The VA rated the asthma condition 30% under the same code.  A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  While PFT’s in evidence did not warrant a 30% rating (the next higher rating than the PEB’s 10%), Board members considered that inhaled anti-inflammatories were prescribed and used (as noted by multiple exams in evidence, the medication profile, and the NARSUM examiner).  The PEB acknowledged inhalational anti-inflammatory (steroid) use, albeit on what it characterized as an intermittent basis.  Inhalational anti-inflammatory medication use, though, is not specified as a daily requirement under the 30% requirement (as quoted above).  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.  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 recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Mild Persistent Asthma	6602	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140409, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 22 2016

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, AR20160008336 (PD201401654)

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 recharacterize the individual's separation as a permanent disability retirement with the combined disability rating of 30% 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 30% 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