RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02374
BRANCH OF SERVICE:  navy	BOARD DATE:  20150521
SEPARATION DATE:  20091115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Machinist Mate Fireman) medically separated for reactive airway disease.  The condition could not be adequately rehabilitated to meet the physical requirements of her Rating or satisfy physical fitness standards.  She was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The reactive airway disease, characterized as “asthma,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition (allergic rhinitis) for PEB adjudication.  The Informal PEB adjudicated “reactive airway disease” as unfitting, rated 10%, and reduced it to 0% because the condition existed prior to service (EPTS).  The allergic rhinitis was determined to be Category II, contributing to the unfitting condition.  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 20090902	VA – (~1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease	6602	0%*	Asthma	6602	10%	20091216	
Allergic Rhinitis	Category II	Seasonal Allergic Rhinitis	6522	0%	20091216	
Other x 0  (Not in Scope)	Other x 7	
Rating:  0%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20100603 (most proximate to date of separation [DOS]).  *EPTS reduction from 10% to 0%. 

ANALYSIS SUMMARY:  The PEB adjudicated the asthma and allergic rhinitis conditions separately and determined the allergic rhinitis to be a Category II condition.  Throughout the service treatment record the two conditions are evaluated and treated concurrently; therefore, the medical evidence for both conditions is addressed simultaneously. Fitness deliberations, and, when applicable, rating recommendations are addressed separately.

Asthma & Allergic Rhinitis Conditions.  At the service entrance examination dated 21 October 2006 the CI reported a diagnosis of asthma in the fifth grade.  Pulmonary function testing (PFT) performed on 21 November 2006 was normal.  The CI was asymptomatic for asthma symptoms until 2007 when she presented with shortness of breath (SOB) with exertion.  The PFT was repeated on 3 June 2008 which demonstrated findings consistent with mild restrictive airway disease (mild asthma).  A primary care note dated 12 June 2008 noted a diagnosis of allergic rhinitis and documented a trial of Albuterol and Singulair for her respiratory symptoms.  At an allergy follow-up dated 5 November 2008, the examiner noted food allergies, perennial allergic rhinitis, asthma, and Beta II agonist sensitivity (a beta-agonist is a class of medications used to treat asthma).  The CI was treated with Nasonex for allergic rhinitis, an inhaled corticosteroid for asthma prevention, and a beta-blocker as needed for asthma attacks.  The CI reported that she rarely used the beta-blocker because it made “her feel bad.”  The physical examination was normal except for boggy nasal membranes.  A diagnosis of asthma, fair control was rendered and her asthma prevention medication was increased.  A pulmonology consultation dated 6 January 2009 noted reports of SOB primarily with exertion.  The physical examination was significant for prolonged expiration and minimal wheezing with forced exhalation indicative of airflow restrictions.  The examiner noted that asthma was suspected and recommended a repeat PFT.  The PFT performed on 6 February 2009 showed worsening of her pulmonary function after bronchodilation medication (the normal response to bronchodilator medication is increased pulmonary function).  A follow-up pulmonary consultation visit dated 20 March 2009, documented methacholine challenge results consistent with asthma.  Methacholine challenge is a test used to determine whether or not the CI really had asthma.  This test was performed due to her symptoms being consistent with asthma, but her having mildly abnormal PFT results and worsening of pulmonary function with a bronchodilator.  A diagnosis of reactive airway disease (asthma) was rendered.  The examiner noted that the CI was “intolerant of virtually all” asthma medications and prescribed a trial of another asthma prevention medication.

At the narrative summary exam dated 18 May 2009 the CI reported continued SOB with physical activity and at times with regular ambulation.  The examiner noted that the CI’s asthma symptoms were difficult to control because of the side effects experienced with “all available medications.”  The physical examination was normal and a diagnosis of reactive airway disease EPTS was rendered.

At the VA Compensation and Pension examination performed about a month after separation, the CI reported SOB with exertion and that she was not taking any medications due to the side effects.  The pulmonary examination was normal.

Pulmonary Exam	PCC ~9 Mo. Pre-Sep	MEB ~6 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
FEV1 (% Predicted)	72	“Normal Spirometry”	73	
FEV1/FVC	92	“	97	
Meds	Pulmicort, Albuterol	FEV 1=72	No Meds	
§4.97 Rating	30%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the asthma condition as unfitting and rated at 10%, coded 6602 (asthma).  The PEB determined that the condition was EPTS and applied a 10% reduction, resulting in a 0% rating.  The VA rated the condition at 10% for pre-bronchodilator FEV-1 (forced expiratory volume) between 71-80% of the predicted value.  The Board first considered if the PEB’s EPTS reduction was applicable in this case.  Board members agreed that the CI’s reporting of the diagnosis of and treatment for asthma prior to service was clear and unmistakable evidence that the condition was EPTS.  A waiver request was not generated at the time of entry into the service and the CI was asymptomatic without medication use for a year prior to separation.  The Board determined that the condition was EPTS, but the disability rating at the time of entry into service was 0%.  Board members agreed that the PEB EPTS reduction was not applicable in this case.  The Board then considered whether the evidence supported a higher than 10% rating.  There was no evidence of post-bronchodilator FEV-1 between 56-70% for a higher rating.  The Board noted that the CI could not tolerate any asthma medication therefore the preponderance of evidence did not support a 30% or higher rating for: daily inhalational or oral bronchodilator therapy; inhalational anti-inflammatory medication; FEV-1 of 56- to 70-percent predicted (FEV-1 most proximate to separation was 72% post-bronchodilator medication); or FEV-1/FVC of 56 to 70 percent (FEV-1/FVC most proximate to separation was 92%).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 10% for the asthma condition.

Contended PEB Condition.  The Board’s first charge for the Category II allergic rhinitis condition is to assess whether it can be reasonably justified as separately unfitting and service ratable.  The Board’s threshold for such determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The Board’s threshold for countering service fitness determinations requires convincing performance-based evidence.  The allergic rhinitis condition was not listed on the limited duty form and was controlled by medications, and members agreed that the subsumed Category II allergic rhinitis condition was not reasonably justified as separately unfitting.  Considering the totality 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 Category II determination for the allergic rhinitis condition and so no additional disability rating 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.  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, the Board unanimously recommends a disability rating of 10%, coded 6602 IAW VASRD §4.97.  In the matter of the contended allergic rhinitis conditions, the Board unanimously recommends no change from the PEB’s Category II designation.  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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Reactive Airway Disease	6602	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
		     DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
       RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
      (b) PDBR ltr dtd 31 Aug 15 ICO XXXXXXXXXXXXXXX
      (c) PDBR ltr dtd 16 Jul 13 ICO XXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 31 Aug 15 ICO XXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 28 Aug 15 ICO XXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 31 Aug 15 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay effective date of discharge with a 10 percent disability rating (increased from 0 percent).

     b. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge (9 Jun 2002). ****

     c. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay effective date of discharge with a 20 percent disability rating (increased from 10 percent).

     d. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay effective date of discharge with a 20 percent disability rating (increased from 10 percent).

     e. XXXXXXXXXXXXXXX, former USN:  Entitlement to disability severance pay effective date of discharge with a 10 percent disability rating (increased from 0 percent).

****This case was previously adjudicated on 27 Aug 2013.  That decision erroneously listed the PDRL date as 2009 vice 2002.  Correction is now required to ensure service member receives appropriate compensation.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.