RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03094
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20041218	     
DATE REMOVED FROM TDRL:  20071105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active Reserve O3, Human Resource Officer, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” rated at 10%.  

CI CONTENTION:  The CI requests that his file be reviewed “for accuracy and fairness.”  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 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 PEB – 20041103/20071001	VARD - 20060127	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	Asthma	6602	30%	30%	
Obstructive Sleep Apnea	Not Unfitting	Sleep Apnea	6847	0%	0%	
Psoriasis		Psoriasis	7816	10%	10%	
Shin Splints		Right Leg Strain (Claimed as Recurrent Shin Splints)	5299-5262	0%	0%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 2002 after an upper respiratory tract infection.  An inhaled bronchodilator (albuterol) was prescribed on an “as needed” basis in February 2003, and inhaled anti-inflammatory medications were added later the same year.  Despite continued treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “moderate persistent asthma” for PEB adjudication.  According to the MEB NARSUM on 8 October 2004, 3 months pre-TDRL placement, the examiner noted prescriptions for twice-daily inhaled bronchodilator (albuterol) and a daily inhalational anti-inflammatory (fluticasone).  The examiner stated that inhaled corticosteroids (inhalational anti-inflammatory medication) were required for asthma control.  Pulmonary function testing (PFT) on 14 October 2004 showed an FEV-1 (forced expiratory volume in 1 second) of 110% of predicted and an FEV-1/FVC (forced vital capacity) of 76%.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician and no evidence documenting the use of oral or parenteral steroids for asthma during the year prior to TDRL placement.  

At a TDRL examination on 15 November 2005, 11 months post-TDRL placement, the CI reported shortness of breath and asthma symptoms despite use of prescribed medications, which included an oral bronchodilator (montelukast), an inhalational anti-inflammatory/bronchodilator (fluticasone/salmeterol), and a bronchodilator (albuterol).  The examiner noted “poorly controlled moderately severe asthma.”  Pulmonary function testing documented an FEV-1 of 89% predicted and an FEV-1/FVC of 72%.  The examiner recommended the CI be continued on the TDRL, which the PEB elected to do.  

At the 12 January 2006 VA Compensation and Pension (C&P) evaluation, performed 12 months pre-TDRL removal, the examiner noted the CI was taking inhalational anti-inflammatory medication and daily bronchodilator medication (the particular medications were not specified).  The CI reported no lost work.  Pulmonary function testing documented an FEV-1 of 83% of predicted and an FEV-1/FVC of 83%.  

At an allergy consultation dated 2 May 2006, 6 months pre-TDRL removal, the CI was prescribed a 5 day dose of oral (systemic) corticosteroids for symptomatic asthma, was advised to comply with the twice daily dosing of his inhalational anti-inflammatory/ bronchodilator (fluticasone/salmeterol), and to continue his oral (montelukast) and inhaled (albuterol) bronchodilators.  On 30 August 2007, 2 months pre-TDRL removal, the CI reported recurrent shortness of breath with exertion, and daily use of an inhaled anti-inflammatory Advair™ (inhalational steroid/bronchodilator combination), oral bronchodilator (montelukast), with use of a bronchodilator (albuterol) 3-4 times monthly for exacerbations.  Pulmonary function testing documented an FEV-1 of 101% predicted and FEV-1/FVC of 77%.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the asthma 30% at TDRL placement coded 6602 (asthma), citing the required use of “daily inhaled corticosteroids and as needed bronchodilators.”  At TDRL removal, the PEB granted a permanent disability rating of 10%, citing the FEV-1 value from the proximate TDRL examination and the requirement for an “intermittent inhaler.”  The VA also rated the asthma 30% coded 6602 (asthma), based on the VA C&P examination dated 12 January 2006, citing the requirement for inhalation or anti-inflammatory medication.  The Board first considered the rating recommendation at the time of placement on TDRL.  The 30% rating criteria stipulates “FEV-1 of 56 to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members agreed that the PEB’s 30% rating was justified by the use of inhaled anti-inflammatory medication at TDRL placement, as noted in the NARSUM examination and acknowledged by the PEB.  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 three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% rating.  

The Board next considered its recommendation for permanent disability rating at the time of TDRL removal.  The VA C&P examiner documented the requirement for inhaled anti-inflammatory medication.  The allergy consultant prescribed a short course of oral corticosteroids and recommended compliance with anti-inflammatory medications.  The TDRL examination dated 30 August 2007 documented “inhaled daily steroids.”  Board members agreed that the 30% rating was justified, as noted in the referenced examinations and as acknowledged by the VA.  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 three per year) courses of systemic corticosteroids.  There was no PFT evidence to support a rating higher than 30%.  

Contended PEB Conditions:  Obstructive Sleep Apnea, Psoriasis, Shin Splints.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma, the Board unanimously recommends no change in the PEB adjudication at TDRL placement; and unanimously recommends a permanent disability rating of 30% at the time of TDRL removal, coded 6602 IAW VASRD §4.71a.  In the matter of the contended obstructive sleep apnea, psoriasis, and shin splints conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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	
		PERMANENT	
Asthma	6602	30%	
RATING	30%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160013317  (PD201403094)

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 re-characterize 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