RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02403		
BRANCH OF SERVICE:  Army	Separation Date:  20031008

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Wheeled Vehicle Mechanic, medically separated for asthma.  The 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 “mild persistent asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “asthma” as unfitting, rated 10%.  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 Veteran’s Affairs Schedule for Rating Disabilities 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:  

IPEB - Dated 20030717	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20030821	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20031024 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Asthma Condition.  The CI developed wheezing and shortness of breath in 2002 and on two separate occasions, he required nebulizer therapy.  Pulmonary function testing (PFT) done in August 2002 demonstrated normal flows and volumes (FVC of 88% predicted and FEV1/FVC of 101%), and a methacholine challenge (provocative test for airway disease) was positive for reactive airway disease (25% decrease in FEV1).  The medical provider started the CI on Atrovent (inhalational bronchodilator) two puffs twice daily, Flovent (inhalational anti-inflammatory medication) two puffs twice daily, and Albuterol (inhalational bronchodilator) two puffs as needed.  The asthma treatment regimen was changed in September 2002 to Advair (inhalational anti-inflammatory medication:  steroid/bronchodilator combination of fluticasone/salmeterol) one puff twice daily, along with Albuterol inhaler as needed.  A treatment note from November 2002 noted non-compliance with medications and the CI was reinstructed on medication use.  The pulmonary consult in December 2003 increased the strength of Advair medication.  

The MEB Narrative Summary (NARSUM) exam, dated 17 April 2003 (approximately 6 months prior to separation), documented that the CI had exertional difficulty breathing (dyspnea) with running approximately one mile.  He reported an increased cough with exercises and required Albuterol pre-exercise.  He was unable to wear his chemical mask for more than 15-20 minutes.  The examiner documented that the CI was compliant with his medications of Advair, Albuterol and Flonase (steroid nasal spray).  The physical exam of the lungs was normal with no wheezing noted.  The examiner noted that the CI‘s symptoms were consistent with moderately persistent asthma.  

The VA Compensation and Pension (C&P) exam approximately 2 months before separation documented that the CI related approximately three attacks of shortness of breath weekly which were relieved with the Albuterol inhaler.  His current asthma medication regimen was Advair inhaler two puffs twice daily and Albuterol inhaler as needed.  The physical exam of the lungs was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 (asthma, bronchial) and rated at 10% citing:  “Asthma, with normal spirometry.  On intermittent inhalational bronchodilator therapy,” and “medication profile shows that soldier last obtained one month supply of Advair on 3 December 2002.”  The VA used the same 6602 coding rated at 30%.  No recorded PFT results would warrant higher than a 10% rating, and the CI did not have respiratory failure, prescribed courses of systemic corticosteroids, or required monthly physician visits.  Therefore, the Board concentrated attention to rating criteria based on medication use.  Both the MEB and C&P examiners documented that the CI was using daily Advair (inhalational anti-inflammatory medication).  The 30% rating criteria for asthma for “inhalational anti-inflammatory medication” does not require daily use.  

The Board agreed that there was sufficient reasonable doubt that the CI was using at least intermittent inhalational anti-inflammatory medication at the time of separation.  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 IAW §4.97.  

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 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.  

RECOMMENDATION:  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:  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140506 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160004495 (PD201402403)

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