RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03698
BRANCH OF SERVICE:  Army	
DATE PLACED ON TDRL:  20050613	DATE REMOVED FROM TDRL:  20060815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” rated at 10%.  

CI CONTENTION:  “Please consider all conditions.”  The 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 – 20050321/20060601	VARD 20050725	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL Removal	
Asthma	6602	30%	10%	Asthma and Pulmonary Coccidioidomycosis	6835-6602	30%	30%	
Pulmonary Coccidioidomycosis, Resolved	Not Unfitting					
RATING:  30% → 10%	RATING:  60%	

ANALYSIS SUMMARY:

Asthma.  From 7 January 2004 to 26 October 2004, this CI was deployed overseas.  After his return to the U.S., he was having symptoms of cough and exertional dyspnea (difficulty breathing).  Multiple treatments with antibiotics were prescribed, without resolution of his pulmonary symptoms.  On 10 February 2005, the CI was seen in the pulmonary clinic and was suspected of having asthma.  He was treated with Advair (an inhaled combination drug containing corticosteroid anti-inflammatory medication), and albuterol (a short-acting beta adrenergic bronchodilator that is often used as a “rescue” inhaler).  An MEB was initiated at that time.  On 17 February 2005, pulmonary function tests (PFTs) were done.  The forced expiratory volume in the first second (FEV-1) was 5.36 liters (113% of predicted).  The FEV-1 divided by forced vital capacity (FVC) was 87%.  These PFTs were interpreted as normal.  

The MEB Narrative Summary (NARSUM) was dated 28 February 2005.  The treatment with Advair had resulted in significant improvement.  However, the CI reported that he could not perform certain exertional activities such as running.  On physical examination (PE) of the lungs, there was mild expiratory wheezing. The NARSUM diagnoses were: “Moderate persistent asthma” and “Pulmonary coccidioidomycosis, resolved.”

The Board carefully examined all available evidence.  As noted above, the CI was found unfit and was temporarily retired at 30%, effective 12 June 2005.  At that time, a rating higher than 30% was not warranted.  The CI’s asthma was not severe enough to justify a rating of 60%.  IAW VASRD §4.97, a rating of 60% would require: FEV-1 of 40% to 55% of predicted, or; FEV-1 divided by FVC of 40% to 55%, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent courses of systemic corticosteroids.  Since the treatment record did not show sufficient evidence of these findings, the Board had no basis to recommend a rating higher than 30%, when the CI was placed on TDRL.  On 17 June 2005, he had a VA Compensation and Pension (C&P) General medical (GenMed) examination.  The CI reported that he was using Advair and albuterol.  On PE, his respiratory rate was 20 breaths per minute.  PE of the chest revealed clear breath sounds bilaterally, with no crepitations or wheezes.  Based on the results of that PE, the VA rated the pulmonary condition at 30%, citing medication use as the justification for a 30% rating.     

On 19 April 2006, after 10 months of TDRL, the CI was evaluated by an Army Allergist. Medications at that time included: Advair, albuterol, and Singulair (a non-steroidal anti-asthma medication that is taken orally in tablet form).  During the previous year, the CI had two Emergency Room (ER) visits for asthma, but did not require Prednisone.  He reported that he awakened three times a week with shortness of breath (SOB), and was using approximately two canisters of albuterol per month.  His cough was chronic, stable, and worse at night.  His wheezing was worse at night, and also worsened with exercise.  On PE, he was in no acute distress.  The lung fields were clear to auscultation.  PFTs were measured, and the FEV-1 was 5.04 liters, which was 102% of predicted.  Bronchodilator treatment increased the FEV-1 to 5.36 liters (109% of predicted).  

The Board carefully reviewed all information available and directed attention to its permanent rating recommendation based on the evidence.  The June 2006 Army PEB rated the CI’s asthma at 10%.  For the reader’s convenience, the VASRD §4.97 language for the 10%, 30%, and 60% ratings (diagnostic code 6602) is excerpted below:

FEV-1 of 40 to 55 percent predicted, or; FEV-1/FVC of 40 to 55 
percent, or; at least monthly visits to a physician for required 
care of exacerbations, or; intermittent (at least three per year) 
courses of systemic (oral or parenteral) corticosteroids .......................................60 

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 .....................................................30 

FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 
percent, or; intermittent inhalational or oral bronchodilator therapy .................10
The Board determined that the best source of information upon which to base a permanent rating recommendation, was the April 2006 TDRL evaluation by the Army Allergist (p.20-24). This PE was 4 months before separation (15 Aug 2006), and therefore had significant probative value.  Using data from that April 2006 examination, the Board determined that at the time of final separation, it was more likely than not, that the CI’s pulmonary condition required the use of Advair on a regular basis.  This would justify a 30% rating.  Advair is an inhaled combination drug containing fluticasone, which is a corticosteroid anti-inflammatory drug.         
 
There was no evidence for respiratory failure, frequent exacerbations requiring physician intervention, or use of systemic corticosteroids.  Therefore, a higher rating of 60% was not justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a permanent disability rating of 30% for the asthma condition.  It is appropriately coded 6602, and IAW VASRD §4.97, meets criteria for the 30% rating level based on required use of inhalational anti-inflammatory medication.       

Contended Condition.  In September 2003, this CI was seen in the pulmonary clinic, and was diagnosed with presumptive pulmonary coccidioidomycosis.  In November 2003, he was started on fluconazole to treat the coccidioidomycosis.  A short time later, on 7 January 2004, he deployed overseas.  He returned to the US in October 2004.  It was after his return from deployment that he was diagnosed with asthma.  On DA Form 3947, the MEB listed one of his medical conditions as: “Pulmonary coccidioidomycosis, resolved.”  The March 2005 PEB adjudicated this condition as “Not unfitting, not rated.”  

The Board’s main charge with respect to this condition is to assess the appropriateness of the PEB’s adjudication.  The Board’s threshold for countering a fitness determination is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  This MEB/PEB condition was thoroughly reviewed and considered by the Board.  The Board determined that there was insufficient evidence in the record that this condition significantly interfered with satisfactory performance of military duties.  The Board determined that the pulmonary coccidioidomycosis condition was treated, and was resolved.  After due deliberation, and in consideration of the preponderance of the evidence, the Board found insufficient cause to recommend a change in the PEB adjudication of this condition.  Therefore, no additional disability rating is recommended.   

BOARD FINDINGS:  In the matter of the unfitting asthma condition, the Board unanimously recommends a permanent Service disability rating of 30%, coded 6602, IAW VASRD §4.97.  In the matter of the pulmonary coccidioidomycosis condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		PERMANENT	
Asthma	6602	30%	
COMBINED	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

AR20160009318, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

 

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 provide you 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, (AHRCO-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,

Enclosure