RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01956
BRANCH OF SERVICE:  Army	BOARD DATE:  20150113
SEPARATION DATE:  20050215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for mild intermittent asthma.  The asthma condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “exercise and cold weather induced reactive airway disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (allergic rhinitis and gastroesophageal reflux disease [GERD]) as medically acceptable.  The Informal PEB adjudicated “mild intermittent asthma” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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/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 IPEB – Dated 20050124	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR	
Allergic Rhinitis	Not Unfitting	No VA Entry	
Gastroesophageal Reflux Disease	Not Unfitting	No VA Entry	
Other x 0 (Not in Scope)	Other x 1	
Rating:  10%	Rating:  0%	
Derived from VA Rating Decision (VARD) dated 20050610 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma.  The CI sought care in June 2004 for a persistent dry cough that had been present for approximately 2 years.  Upon spirometry testing on 9 July 2004, the forced expiratory volume in 1 second (FEV1) was 93% predicted (post bronchodilator), and the ratio of the FEV1 to the forced vital capacity (FEV1/FVC ratio) was 86%.  Repeat spirometry on 13 July 2004 was similar (FEV1 84% predicted and FEV1/FVC ratio of 93%).  Evaluation with methacholine bronchoprovocation testing on 13 July 2004, demonstrated reversible bronchospasm consistent with asthma.  The pulmonary specialist prescribed inhalers (including a steroid and bronchodilator inhaler) which the CI picked up on 29 July 2004.  At the time of follow-up with the pulmonary specialist on 1 September 2004, the CI had not been using the steroid inhaler.  The MEB narrative summary (NARSUM) dated 29 November 2004, noted treatment with steroid and bronchodilator inhalers.  However, there were no STR entries reflecting refill of the prescriptions for the asthma medications from the initial prescription in July 2004 and the time of separation in February 2005.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma at 10% (coded 6602) noting intermittent use of an inhaled bronchodilator.  The Board also noted that pre-treatment pulmonary function test (PFT) results did not support a minimum rating using diagnostic code 6602 since this requires an FEV1 or FEV1/FVC ratio of 80% or lower.  The Board noted the CI was prescribed an inhaled anti-inflammatory medication (inhaled steroid) by the pulmonary physician, which would support consideration of the next higher rating.  However, according to the follow-up pulmonary clinic notes, the CI was not using the medication.  While the MEB NARSUM listed a steroid inhaler, no STR indicated refills of any asthma medications from July 2004 to the time of separation in February 2005.  The PEB also did not note use of the medication. The VA granted a 0% service-connected rating based on the PFT and medication usage, noting the failure to report for the scheduled VA exam.  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 adjudication for the asthma condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the allergic rhinitis and gastroesophageal reflux conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The allergic rhinitis and gastroesophageal reflux conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

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.  In the matter of the asthma condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended allergic rhinitis and gastroesophageal reflux conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150009959 (PD201401956)

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:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA