RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03410
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20021021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Light 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 an Medical Evaluation Board (MEB).  Moderate 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 moderate persistent asthma as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI initially demanded a formal hearing; however, he subsequently withdrew his request 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 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 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:

IPEB – Dated 20020617	VA* - (~1 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Persistent Asthma…	6602	10%	Asthma	6602	10%	20020923	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20021115 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Asthma Condition.  On 11 June 2001, the CI had a positive methacholine challenge test that revealed a 20% decrease in FEV1 which definitively established the diagnosis of asthma.  A chest X-ray was normal.  His symptoms of difficult breathing, shortness of breath, and wheezing worsened with exercise.  His initial treatment consisted of an “as needed” medication of Proventil® (inhalational bronchodilator [Albuterol]) and Aerobid™ (steroid) inhaler.  The service treatment record also noted a second steroid of Budesonide (Pulmicort) was interchangeably with Aerobid.  He was permanently profiled in November 2001 and referred to a MEB.  A spirometry test performed 7 June 2002 (4 months prior to separation) revealed decreased predicted value of FEV1 at 64%.  At the MEB narrative summary (NARSUM) performed on 2 November 2001 (11 months prior to separation); the CI reported difficulty breathing upon exertion, walking uphill, maneuvering stairs, or running.  His physical examination was normal.  There was no history of hospital admissions or use of systemic steroids.  A military treatment facility medication profile listed both the bronchodilator and steroid prescriptions as last being filled on 5 November 2001 (3 days after the NARSUM examination).  The commander’s letter reflected that the CI was unable to wear a protective mask and thus was non-deployable.

At the VA Compensation and Pension evaluation dated 23 September 2002, a month prior to separation, the CI’s chief complaint was, “asthma.”  He reported daily use of both the bronchodilator and steroid medication.  The physical exam was unremarkable and there was no repeat spirometry test documented.  His diagnosis remained unchanged.  The PFT evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Pulmonary Exam	Respiratory
~5 Mo. Pre-Sep
(20020607)	VA
~1 Mo. Pre-Sep
(20020923)	
FEV1 (% Predicted)	64	--	
FEV1/FVC	96 	--	
Meds	Bronchodilator and steroid inhaler	Bronchodilator and steroid inhaler	
§4.97 Rating	30%	30%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA coded the asthma condition utilizing the unequivocal asthma VASRD code of 6602; citing asthma and medication non-compliance by the PEB and simply listing VASRD criteria by the VA.  VASRD §4.97 defines both PFT (spirometry)-derived criteria and clinical treatment criteria for rating under 6602.  In this particular case, the spirometry measures of 64% predicted in FEV1 and or the medication use of “daily inhalational or oral bronchodilator therapy, or; non-daily inhalational anti-inflammatory medication” as evidenced in both the 5- month and 1-month pre-separation examinations clearly supported a 30% impairment rating.  The record did not determine the CI was placed on oral corticosteroids; and therefore the higher 60% rating was not considered.  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.

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 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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140714, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB							
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 XXXXXXXXXX, AR20160004313 (PD201403410)

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