RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxx	CASE:  PD-2014-02017
BRANCH OF SERVICE:  Army	BOARD DATE:  20141014
SEPARATION DATE:  20020825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92A/Automated Logistics Specialist) medically separated for an asthma condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “moderate persistent allergic asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “asthma” as unfitting, rated 0% specifically citing “…as soldier is not compliant with medical management.”  The CI made no appeals and was medically separated.

CI CONTENTION:  The applicant requests all conditions be considered.

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 20020607	VA* - (Service Treatment Records (STRs))	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	10%*	STRs	
Other x 0 (Not in Scope)	Other x 4	
Combined:  0%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20030611 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  

Asthma Condition.  The CI had no prior history of asthma.  In July 2001, he developed shortness of breath with exertion while stationed in Korea.  His symptom progressively worsened, when he developed non-productive cough and wheezing with less exertion and even with exposure to fumes, air fresheners, and perfumes.  Although his initial pulmonary function tests (PFTs) were completely normal, a pulmonologist performed a Methacholine challenge test (a provocative test for airway hyper-responsiveness) in January 2002.  That test was markedly positive and the CI was diagnosed with mild persistent asthma.  He was treated with an Albuterol inhaler, on an as needed basis, that resulted in a decrease of his nocturnal symptoms.  The pulmonologist also recommended maximal medical therapy to include Advair (inhaled anti-inflammatory medication) and Singulair in addition to his Albuterol.  He was then referred into the Disability Evaluation System.  The medication profile present for review documents that the CI only received only one of five prescriptions for the medications Advair, Singulair and Albuterol.  The narrative summary (NARSUM) prepared 3 months prior to separation noted that the CI experienced asthma on “more than moderate exertion” and was not able to complete the two mile fitness test within the required time, even with his inhaler.  The pertinent physical exam was normal and his PFTs were normal except for the FEV1/FVC which was 78 (normal >80).  The NARSUM documented the CI’s current medication as “Advair, Singulair and Albuterol.”  The CI was diagnosed with moderate persistent asthma and the provider added the following statements in the present condition section:

“PFC Exxx is relatively symptom-free when doing sedentary work in an air-conditioned office.  He has significant asthma symptoms when exposed to irritants/allergens.  While his symptoms have improved slightly while on medication, he is still unable to function effectively.  Future improvement is unlikely.”

The CI failed to report for his VA Compensation and Pension exam that was scheduled on 26 February 2003.  The VA granted him a 10% rating for asthma based on his STRs.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB applied code 6602 (bronchial asthma) and rated it 0% specifically citing “Rated at 0% as soldier is not compliant with medical management.”  The VA also applied code 6602 but rated it 10% based on the STRs and citing the VASRD criteria for the 10% rating.  The evidence supports that the CI did have asthma and that he was prescribed inhaled bronchodilator medication on an as needed basis and an inhaled anti-inflammatory medication was recommended.  Inhaled anti-inflammatory medication use is required for a 30% rating under code 6602.  The evidence also supports that the CI picked up only one of five prescription refills for his asthma medications and that well after separation he was not using the inhaled anti-inflammatory medication, which the PEB cited as evidence for its 0% rating.  The evidence documents that the CI had only one abnormal PFT result, the FEV1/FVC of 78% noted on the NARSUM, which is consistent with a 10% rating.  Although it was determined that the CI was prescribed Advair for daily use, the evidence makes clear that the CI did not engage in the daily use of the medication as his asthma condition did not require use of that medication.  Member consensus was, therefore, that only the criterion of “intermittent” use (as specified in the 10% rating description) was satisfied in this case.  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.

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, the Board, by a majority vote, recommends a disability rating of 10%, coded 6602 IAW VASRD §4.97.  The single voter for dissent submitted the appended minority opinion.  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:

UNFITTING CONDITION	VASRD CODE	RATING	
Asthma	6602	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MINORITY OPINION:

As written in the Record of Proceedings above, “The evidence supports that the CI did have asthma and that he was prescribed inhaled bronchodilator medication on an as needed basis and an inhaled anti-inflammatory medication was recommended.  Inhaled anti-inflammatory medication use is required for a 30% rating under code 6602.”

The Board consensus determined, “Although it was determined that the CI was prescribed Advair (inhaled anti-inflammatory medication) for daily use, the evidence makes clear that the CI did not engage in the daily use of the medication as his asthma condition did not require use of that medication.”

Additionally, the Board consensus determined, “The evidence also supports that the CI picked up only one of five prescription refills for his asthma medications and that well after separation he was not using the inhaled anti-inflammatory medication.”  However, it is the Board minority’s position that the prior statement offers “reasonable doubt” that the CI was utilizing an inhaled anti-inflammatory (Advair) at the time of separation.

The Board consensus final determination was that only the criterion of “intermittent” use [of inhaled bronchodilator medication] (as specified in the 10% rating description) was satisfied in this case.

However as written in the Record of Proceedings above, The narrative summary (NARSUM) prepared 3 months prior to separation noted that the CI experienced asthma on “more than moderate exertion” and was not able to complete the two-mile fitness test within the required time, even with his inhaler.  …The NARSUM documented the CI’s current medication as “Advair [inhaled anti-inflammatory medication], Singular and Albuterol.”  The CI was diagnosed with moderate persistent asthma.

It is integral to note, the VASRD grants a 30% rating for asthma (6602) for “inhalational anti-inflammatory medication,” the VASRD does not require daily use.  

Consequently, it is the Board minority’s determination based on the provided evidence and VASRD §4.3 (reasonable doubt), that the CI required an inhalational anti-inflammatory medication, was prescribed Advair, and it was utilized at some unknown frequency at the time of separation.  There is no evidence to show that this medication requirement was revoked prior to separation.

The Board minority 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.

UNFITTING CONDITION	VASRD CODE	RATING	
Asthma	6602	30%	
COMBINED	30%	

SAMR-RB

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
25118TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

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 xxxxxxxxxxxxxxxxxxxxx, AR20150018388 (PD201402017)

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:
 
Deputy Assistant Secretary of the Army

CF:
( ) DoD PDBR
( ) DVA