RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02004
BRANCH OF SERVICE:  Army	BOARD DATE: 20150416
DATE OF PLACEMENT ONTO TDRL:  20021015
DATE OF REMOVAL FROM TDRL:  20040519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Electrical Fuel System Repair) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “bronchoconstriction” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “asthma - exertion related” as unfitting, rated 30%, with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was placed on the Temporary Disability Retired List (TDRL).  Approximately 2 years later, the IPEB adjudicated the asthma condition as unfitting, rated 0% with likely application of the VASRD.  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 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 – 20040220	VA Rating Decision1 - 20050603	
TDRL Placement – 20021202	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL2 Removal	
Asthma	6602	30%	0%	Asthma	6602	N/A	0%	
Other x 0	Other x 2	
RATING: 30% → 0%	RATING:  0%	
1. Most proximate to TDRL Placement
2. Non-compensable evaluation due to failure to show for scheduled examination.
3. PEB rating for TDRL removal based on C&P exam dated 20040113, ~4 mos. pre-TDRL removal

ANALYSIS SUMMARY:

Asthma.  The MEB narrative summary (NARSUM) noted that in May 2001 the CI presented with symptoms of dyspnea (shortness of breath), chest tightness, cough, and dyspnea after running.  The CI was a smoker and stated that he had been working at the Post battery shop over the past year, where he had been exposed to a lot of fumes.  At the time of evaluation by pulmonary medicine (lung specialist) on 2 August 2001, baseline spirometry showed an FEV1 (forced expiration over one second) at 3.69 liters (82% of predicted), FVC (total air expelled) at 5.07 (95% of predicted), and an FEV1/FVC ratio of 73%.  After exercise the FEV1 decreased by 22%.  The pulmonary physician noted the significant decrease in FEV1 with exercise and diagnosed exercise-induced bronchospasm.  The CI was prescribed Flovent (inhaled corticosteroid, an anti-inflammatory medication) and Albuterol (a bronchodilator).  Due to persisting symptoms limitation to avoid fumes he was unable to function as a fuel and electric systems repairer and was referred for MEB.  At the MEB examination on 10 July 2002, 5 months prior to TDRL placement, the lungs were “normal” (breath sounds normal on auscultation), and a chest X-ray was normal.  The examiner stated, “Uses MDI [multi-dose inhaler] (Flovent, Ventolin).”  At the time of the MEB NARSUM examination on 24 September 2002, the CI reported he did not feel that he could perform his MOS duties because he worked around fumes and there was poor ventilation where he worked; could not wear the protective mask, and could not perform the 2-mile run for his physical fitness test.  Listed medications included Flovent and Proventil however the CI stated that his symptoms had not improved since being placed on medication.  On examination the lungs were clear without wheezing.  The MEB NARSUM referred to the spirometry performed in August 2001.  At a VA pulmonary examination on 13 January 2004, 13 months after TDRL placement and 4 months prior to removal from TDRL and permanent disability disposition (TDRL removal), the CI reported that he had discontinued his medication after returning to the northeast area of the U.S., and had no significant pulmonary symptoms (although he continued to smoke).  He had recently tried running 0.75 miles with 10 pounds of equipment and had no difficulty with wheezing or shortness of breath.  Pre-bronchodilator spirometry showed FEV1 at 3.63 liters (81% of predicted), FVC at 4.96 (93%), and FEV1/FVC ratio of 73% (no significant change after bronchodilator).  This VA examination was used by the PEB for its final disability determination in lieu of a separate military examination.

The Board directed its attention to its rating recommendation for TDRL placement based on the above evidence.  The PEB rated the condition under code 6602 (Asthma) at 30%, citing the use of daily inhaled corticosteroids, and pulmonary function that was essentially normal on treatment (noting the reduction in the FEV1 with exercise).  The VA found the condition to be service-connected, but did not assign a rating because the CI failed to report for a scheduled VA examination.  The Board found that the CI had been prescribed (and was apparently using) daily inhaled corticosteroids, which supported a 30% rating under code 6602 (FEV-1 of 56%-to 70% predicted, or; FEV1/FVC of 56% to 70%, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication).  A higher rating was not supported by spirometry values, a history of visits to a physician at least monthly for required care of exacerbations, or courses of systemic (oral or parenteral) corticosteroids.  The Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition at TDRL placement.  Next, the Board turned its attention to the permanent (final) rating at TDRL removal.  The VA C&P examination was performed on 13 January 2004, 4 months prior to TDRL removal, and was discussed above.  The service did not accomplish a separate MEB examination.  The PEB rated the condition under code 6602 at 0%, noting that the CI was not taking any medication for asthma, had an FEV1 of 81% of predicted (from the C&P exam), and had recently run 0.75 miles with a 10-pound weight without difficulty.  The Board noted that the FEV1/FVC ratio of 73% supported a 10% rating under code 6602.  A higher rating was not supported by spirometry values, a history of visits to a physician at least monthly for required care of exacerbations, or courses of systemic corticosteroids.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the asthma condition at TDRL removal.

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 at TDRL placement, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the asthma condition at TDRL removal, the Board unanimously recommends a permanent disability rating of 10%, coded 6602 IAW VASRD §4.97.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Asthma 	6602	30%	10%	
COMBINED	30%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150013517 (PD201402004)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

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.   

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:

Encl			XXXXXXXXXXXXXXX
				Deputy Assistant Secretary of the Army
				     (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA