RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02967
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20050606	DATE REMOVED FROM TDRL:  20080725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Patriot Missile Systems Operator Mechanic, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” with a disability rating of 10%.  

CI CONTENTION: “Please consider all conditions.”  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 on 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 – 20080630	VARD - 20090324	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	Bronchial Asthma	6602	30%	30%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 1997, at which time inhaled bronchodilator therapy was initiated for treatment.  A diagnostic test on 4 February 2005, approximately 4 months prior to TDRL entry, confirmed moderate to severe airway hypersensitivity consistent with asthma.  Pulmonary function testing (PFT) at that time showed an FEV-1 of 72% of predicted and an FEV-1/FVC of 71%; however, post-bronchodilator measurements were not provided.  According to the pulmonary clinic evaluation on 17 February 2005, the examiner noted the CI used Advair (inhaled combination of bronchodilator and anti-inflammatory) twice daily for several years.  He also used Singulair (oral bronchodilator) at bedtime and a rescue inhaler (bronchodilator) as needed.  The CI reported worsening of his symptoms despite medication compliance and was unable to perform any running activities.  The examiner stated that daily medications were required for asthma control, and instructed the CI to continue his current medical therapy.  

At the MEB examination (recorded on DD Forms 2807 and 2808) on 28 February 2005, the examiner noted that the asthma was controlled by medications.  Advair and Singulair were listed as current medications.  Review of the STR showed no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to TDRL entry.  The MEB NARSUM examination, on 1 March 2005, noted that the CI was using Advair twice daily, Singulair daily, and a bronchodilator as needed and prior to exercise.    

The Board directed attention to the TDRL entry rating recommendation based on the above evidence. The PEB assigned a 30% rating under the 6602 code (asthma, bronchial), citing medication use.  No VA rating was assigned proximal to TDRL entry.  Board members considered that the pulmonary and MEB NARSUM examiners reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were also prescribed and used.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and inhalational anti-inflammatory medication use.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least 3 per year) courses of systemic corticosteroids.  There was likewise no PFT evidence that supported a rating higher than 30% (FEV-1 of 40- to 55-percent predicted, or FEV-1/FVC of 40 to 55 percent).  After due deliberation, considering all 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 adjudication for the asthma condition at TDRL entry.  

The TDRL re-evaluation NARSUM examiner, on 28 May 2008, 2 months prior to removal from TDRL, noted the CI was using Advair 1-2 puffs twice daily, and Singulair “on a regular basis.”  He experienced worse exertional shortness of breath if he forgot to use his medication, and required use of a rescue inhaler 2-4 times per week.  He denied any emergency room visits for asthma since his prior evaluation.  After bronchodilator administration, PFT’s showed an FEV-1 of 79% of predicted and an FEV-1/FVC of 73%.  The examiner stated that the asthma condition was not significantly changed since prior evaluation.

At a VA Compensation and Pension (C&P) examination, on 18 November 2008, 4 months after removal from TDRL, the examiner noted that the CI was using Advair daily, Singulair daily, and albuterol once weekly.  The CI reported he was unable to run or perform vigorous exercise and had to wear a mask outside when he was exposed to dust or pollen.  At a second C&P examination, on 22 January 2009, 6 months after removal from TDRL, the CI reported his asthma was well controlled with the same medications (Advair, Singulair).  Asthma prevented sports participation and flared up in his job when in attics or around cats.  PFT’s after bronchodilator administration showed an FEV-1 of 86% of predicted and an FEV-1/FVC of 75%.  Review of the STR showed no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to TDRL exit.  Although the available medication profiles did not support that Advair was used twice per day during the year prior to removal from TDRL, there was support for regular use.

The Board directed attention to the permanent rating recommendation after removal from TDRL based on the above evidence.  The PEB assigned a permanent 10% rating under the 6602 code citing “at least occasional medication noncompliance” as a rationale.  The VA assigned a 30% rating using the same code.  A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70%, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  At the time of the TDRL re-evaluation NARSUM exam 2 months prior to removal from TDRL, the CI reported using inhaled anti-inflammatories “on a regular basis.”  At both VA C&P exams, 4 months and 6 months after removal from TDRL, the CI reported taking his medications as prescribed.  Although the available medication profile did not reflect twice daily use of inhaled anti-inflammatory medication during the year prior to removal from TDRL, it was also not inconsistent with regular use.  Moreover, the frequency of rescue inhaler use proximal to the time of removal from TDRL was consistent with asthma controlled by anti-inflammatory medications.  The Board agreed that since the “inhalational anti-inflammatory medication” stipulation does not specify “daily” the 30% rating was reasonably satisfied in this case.  The PFT evidence supported a 10% rating (i.e. for FEV-1 of 71- to 80% predicted, or FEV-1/FVC of 71 to 80%).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a permanent disability rating after removal from TDRL of 30% for the asthma condition.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends no change in the TDRL entry rating and unanimously recommends a permanent disability rating after removal from TDRL of 30%, coded 6602,  IAW VASRD §4.97.  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	RATING	
		TDRL	PERMANENT	
Asthma	6602	30%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011095,  

Dear 

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provideyou with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.   Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure