RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03792
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20060831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “history of asthma with continuing shortness of breath,” with a disability rating of 10%.

CI CONTENTION:  The CI asserts that he is currently rated by the Veterans Administration (VA) at 30 percent for asthma, 100 percent for depression and 10 percent for hypertension.  He further contends that he has other conditions which are secondary to the listed conditions and feels he should have been rated 30 percent or more at the time of discharge.  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 upon a 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 - 20060616	VARD - 20061010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Asthma with continuing Shortness of Breath	6602	10%	Asthma with Obstructive Pulmonary Disease and Obstructive Sleep Apnea	6847-6602	30%	20060525	
High Blood Pressure	Cat II	Hypertension	7101	10%	20060525	
Major Depression		Major Depressive Disorder	9434	10%	20060619	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Asthma.  The service treatment records (STRs), the Medical Evaluation Board (MEB) narrative summary (NARSUM) dated 1 February 2006, and the NARSUM Addendum dated 17 March 2006 indicated the CI was diagnosed with asthma in May 2004, which initially was treated with Advair (fluticasone/salmeterol, an inhalational steroid/bronchodilator combination) and albuterol (an inhalational bronchodilator) with fair control.  Singulair (montelukast - an oral indirect acting bronchodilator) was added to the regimen, but symptoms were not well controlled.  The CI completed two periods of limited duty and the persistent nature of the asthma with exercise limitation, treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “asthma” for PEB adjudication.

Pulmonary function testing on 21 July 2005 revealed FVC (forced vital capacity) of 70% predicted and FEV-1 (forced expiratory volume at 1 second) 68% predicted with a FEV-1/FVC ratio of 78%.  After albuterol FVC was 77% predicted and FEV-1 was 82% predicted.  His vital capacity was 88% predicted, total lung capacity 71% predicted, and a residual volume of 59% predicted.  His DLCO (diffusing capacity of the lung for carbon dioxide)/VA (alveolar volume) was 163% predicted.  The asthma, based on frequency of symptoms, was mild persistent and his shortness of breath was most likely multifactorial with asthma being one etiology as well as his high body mass index being contributory.  

At the time of the NARSUM examination on 1 February 2006, 7 months before separation, the CI continued to have shortness of breath once or twice a week and nighttime symptoms once a week.  He had difficulty with exercise and was unable to run 1/2 of a block before developing shortness of breath.  On examination his blood pressure was 144/78, heart rate 70 beats per minute, height 64 inches, weight 240 pounds, and a body mass index (BMI) of 41.19, which increased from an initial evaluation BMI of 29 conducted in 2004.  His lungs were clear to auscultation bilaterally and his heart rate and rhythm were regular.  There were no murmurs, gallops, or rubs and the S1 and S2 sounds were normal.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 23 March 2006, 5 months prior to separation, the CI reported asthma for the prior 2 years.  There were no physical findings noted related to the lungs and chest, but the examiner recorded “asthma stable” in the summary of defects and diagnoses.  

At the 25 May 2006 VA Compensation and Pension (C&P) examination,  performed 3 months before separation, the CI reported pain and discomfort over the chest area with exertion and inability to catch his breath after physical activity.  His height was recorded as 66 inches and weight of 212 pounds.   Examination of the lungs revealed symmetric breath sounds without rhonchi (course rattling respiratory sounds) or rales (crackling sounds) and the expiratory phase was within normal limits.  Pulmonary function studies are in the chart below.  The VA impression was obstruction with improvement from medication and noted 59% predicted FEV-1 best represented the CI’s disability.

The pulmonary function evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Pulmonary Exam	NARSUM ~14 Mos. Pre-Sep
	VA C&P ~3 Mos. Pre-Sep
	
FEV1 (% Predicted)	68 pre-bronchodilator/82 post	39 pre-bronchodilator/85 post	
FEV1/FVC	78 pre-bronchodilator/87.4 post	59 pre-bronchodilator/86 post	
Meds	Advair/Singulair/albuterol	Advair	
§4.97 Rating	30% (PEB 10%)	VA 30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a rating of 10% using code 6602 (asthma, bronchial) for a history of asthma with continuing shortness of breath.  The VA assigned a 30% rating using code 6847-6602 for asthma with obstructive pulmonary disease and obstructive sleep apnea.  A 30% rating 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.”  An inhaled anti-inflammatory medication, which is not specified as a daily requirement under the 30% rating provision, was also required.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was satisfied in this case on the basis of 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 three per year) courses of systemic corticosteroids and there was no PFT evidence to support the next higher 60% rating.  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.  

Contended PEB Condition-Major Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that major depression was not unfitting.  The major depression condition was not listed in the Limited Duty Medical Duty Report or implicated in the Non-Medical Assessment.  There was no performance-based evidence from the record that major depression condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for major depression; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended major depression 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 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	PERMANENT RATING	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140822, w/attachments
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 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 26 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX

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

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 
     i. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 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)