RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02950
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20061231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, General Service Marine, medically separated for “exercise-induced bronchospasm,” with a disability rating of 10%.

CI CONTENTION:  The CI asserted the Veterans Administration awarded him 80 percent for his service connected disabilities.  He further contended that a full medical and dental evaluation was not performed at the time of his discharge.   The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20061113	VARD - 20071012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise-Induced Bronchospasm	6602	10%	Obstructive Airway Disease…	6699-6602	60%	20070719	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Exercise-Induced Bronchospasm.  The service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented that the CI was diagnosed with exercise induced bronchospasm (asthma) in July 2006, after provocation testing (methacholine challenge).  Inhaled bronchodilators were prescribed and inhaled immunosuppressants were started in August 2006.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and an MEB was recommended.  The MEB forwarded “exercise-induced bronchospasm” for PEB adjudication.  

At a pulmonary consultation in August 2006 (4 months pre-separation), the CI reported a night time cough interfering with sleep despite inhaled immunosuppressants (Advair).  Physical examination showed clear lungs without wheezing.  The examiner confirmed the diagnosis and prescribed oral immunosuppressants (prednisone) for 2 weeks.  At the MEB examination (documented on DD Forms 2697, 2807-1, and 2808) dated 25 and 27 September 2006, (3 months pre-separation), the CI reported taking bronchodilators and inhaled immunosuppressants (Advair).  The lung and chest examination was marked “normal.”  The MEB NARSUM examination was performed on 29 September 2006.  The CI reported no improvement despite oral and inhaled immunosuppressants.  Physical examination showed clear lungs bilaterally without wheezing.  The examiner referred the CI for an MEB for inability to control his bronchospasm.  There was no evidence that asthma exacerbations were frequent enough to require monthly visits to a physician.  There were no pulmonary function tests in evidence that documented a forced expiratory volume in 1 second (FEV-1) or FEV-1/ forced vital capacity (FVC) ratio less than 76% predicted.  

At the VA Compensation and Pension (C&P) examination performed on 19 September 2007 (9 months post-separation), the CI reported taking a bronchodilator and that his previous inhaled immunosuppressant (Advair) had been ineffective with persistent symptoms of shortness of breath, daily cough, difficulty breathing through the night, and wheezing.  It was unclear whether or not he was continuing to take his inhaled anti-inflammatory medication.  He denied hospitalizations.  Physical examination showed wheezing on the right with no accessory muscle use (extra effort in breathing) and normal ability to speak without shortness of breath.  PFTs obtained on 18 September 2007 showed an FEV-1 and an FEV-1/FVC of 93% and 82%, respectively.  At an internal medicine consultation October 2007 (10 months after separation), the CI reported improvement in symptoms from September 2007.  Physical examination showed no evidence of wheezing.  The examiner stated that the CI had “borderline moderate persistent” asthma with an FEV-1 of 80%, and added an inhaled immunosuppressant to his therapy.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the “exercise-induced bronchospasm” as unfitting, rating 10% and coded 6602 (bronchial asthma).  The VA rated 60% for the “obstructive airway disease” analogously coded 6699-6602 citing persistent symptoms while taking inhaled immunosuppressants.  The VASRD 60% rating for asthma specifies a minimum of three courses of oral steroids in a year or exacerbations treated by a physician occurring at least monthly.  There was documentation of only one course of systemic (oral) immunosuppressants given 3 months prior to separation.  There were several routine clinic visits for follow-up and no documentation of any visits to a physician for required care of exacerbations in the before or after separation period.  There were no PFTs that documented an FEV-1 or FEV-1/FVC of 40-55%.  Therefore, a 60% rating was not supported.  The 30% rating for asthma specifies “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  There was documentation of daily inhalational anti-inflammatory medication therapy both pre- and post-separation to support a rating of 30%.  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 exercise-induced bronchospasm condition.

BOARD FINDINGS:  In the matter of the exercise-induced bronchospasm, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Exercise-Induced Bronchospasm	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140612, 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 21 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 03 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 17 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 15 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 13 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 13 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 15 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (l) are approved.

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

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effect date of discharge. 

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge. 
 
     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
     
     d. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 
 
     f. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 

     g. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     i. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     j. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effect date of discharge.

     k. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

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.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)