RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03505
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Machine Gunner, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  The applicant contended for asthma and eight other conditions not listed on the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB).  The applicant’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 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 - 20070508	VARD - 20071115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20070725	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  The CI was evaluated in January 2007 for a recent history of recurrent exertional shortness of breath, wheezing and exercise intolerance.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  According to the pulmonary clinic appointment on 26 January 2007 the CI was taking Albuterol (inhalational bronchodilator), and Advair (inhalation steroid/anti-inflammatory) and Singulair (oral bronchodilator) were added to his medication regiment.  

According to the pulmonary clinic evaluation on 6 March 2007 (6 months prior to separation) the examiner noted that the CI “had not been using any meds whatsoever.”  The examiner noted the treatment plan was to continue Advair.  At the follow-up pulmonary appointment on 27 March 2007, the CI reported taking Albuterol and Advair.  The CI reported ongoing activity limitations due to asthma.  On examination, there was objective evidence of airflow limitation and falling oxygen saturation with activity.  

The condition did not respond sufficiently to treatment and he was referred for an MEB.  According to the narrative summary (NARSUM) evaluation on 28 March 2007 (5 months prior to separation) the examiner noted that the CI was using his albuterol several times daily.  The CI reported he took his medications “faithfully” which included Advair.  Pulmonary function testing (PFT) showed an FEV-1 of 78% predicted post-bronchodilator, noted to be essentially unchanged from initial values.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated April 2007, 5 months prior to separation, the CI listed Albuterol, Flonase and Salmeterol (bronchodilator) as his current medications.  His Salmeterol was prescribed for twice a day usage and was last filled on 6 March 2007.  Lung examination showed moderate mid and end expiratory airflow limitation on forced exhalation with terminal expiratory wheezing.  

At the VA Compensation and Pension (C&P) examination on 25 July 2007, performed approximately 1 month before separation, the CI reported he continued to experience asthma attacks weekly and had difficulty with exercising and running.  He denied any emergency room evaluations or hospitalizations.  He reported use of Albuterol “as needed” and was given anti-inflammatory medication.  PFTs showed an FEV-1 of 83% of predicted and an FEV-1/FVC of 81%.  On examination there were normal breath sounds with evidence of mild prolongation of the expiratory phase without evidence of wheezing, rhonchi or rales.  Chest radiographs were unremarkable.  Review of the service treatment record (STR) showed no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6602 code (asthma, bronchial), citing (per the PEB worksheet – JDETS) FEV-1 of 71- to 80-percent predicted and uses inhaler several times a day.  The VA assigned a 10% rating using the 6602 code based on the VA C&P examination 1 month before separation, citing intermittent use of inhalers.  

Board members considered that the service examinations in evidence reported current prescription and use of daily bronchodilators.  There was also prescription of, and at least episodic use of, inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator use and/or use of inhalational anti-inflammatory medication.  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, coded 6602.  

BOARD FINDINGS:  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.  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 prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140702, 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 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXXXX

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

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXXXX , former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge. 

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

     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 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) effective 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)