RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03952
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “asthma,” with a disability rating of 20%.  

CI CONTENTION:  “Please consider all conditions.”  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 - 20020705	VARD - 20030709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Asthma	6602	30%-10% (EPTS)	Asthma	6602	30%	20030613	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in November 2001 for a recent history of recurrent exertional shortness of breath.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  The condition did not respond sufficiently to treatment and he was referred for an MEB.  According to the CI’s entrance physical (SF 88 and SF 93) dated 31 August 1999, the CI reported that he did not have asthma.  The examination revealed normal lungs and chest.  According to the primary care evaluation on 17 May 2001 (16 months prior to separation), the CI complained of episodes of wheezing and tightness in his chest that occurred 2-3 times a day for approximately 60 minutes.  The examiner prescribed albuterol (inhalational bronchodilator), two puffs before exercise.  PFTs in October 2001 documented a significant decrease with exercise with post-bronchodilator values showing slight obstruction (of FEV1 82 [normal] and FEV1/FVC 78 percent).  

According to the internal medicine evaluation on 16 November 2001 (10 months prior to separation), the examiner stated that daily medications were required for asthma control, and instructed the CI to use Flovent (inhalational anti-inflammatory medication) and Serevent (inhaled bronchodilators) twice a day as well as Singulair (oral bronchodilators) at bedtime.  According to the internal medicine evaluation on 19 March 2002 (6 months prior to separation), the examiner recorded no improvement in symptoms and added Combivent (inhalational bronchodilator) to the CI’s medication regimen (of Flovent, Serevent, and Singulair).  

Review of the 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.  

At the VA Compensation and Pension (C&P) examination on 16 June 2003, performed 9 months after separation, the CI reported daily flare-ups of asthma and use of albuterol inhaler 3 times per day.  Pulmonary exam was normal.  PFTs showed post-bronchodilator FEV1/FVC of 76 percent with normal FEV1.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 30% under code 6602 (asthma), but reduced the rating, stating:  “PreExisting Condition – Reduced by 10%” for a final 20% disability rating.  The PEB worksheet (JDETS) referenced “+EPTS factor (used inhaler as child).”  The VA rated the asthma condition 30% (coded 6602) citing requirement for daily inhalational therapy.  It was agreed that “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” was not evident in the available STR.  Therefore, a 60% rating was not warranted.  

Board members agreed that the PEB’s original 30% determination was justified by daily bronchodilator use and/or inhalational anti-inflammatory use.  Board members also agreed that the 10% reduction was not justified because the CI’s entrance physical indicated that he did not have asthma or shortness of breath when he entered the Service.  He was not taking medications (inhalational or oral bronchodilator therapy) and the MEPs exam would therefore have been rated as “undeterminable” or 0%.  There were no PFT evaluations that would result in any rating higher than 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 30% for the asthma condition, coded 6602, with no deduction.  

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%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140903, 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 15 Apr 16 ICO XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 09 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXX 
	(i) PDBR ltr dtd 14 Apr 16 ICO XXXXXXXXXXXXXXXXXX

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

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

     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 
     
     i. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 70 percent disability rating (increased from 10 percent) effect date of discharge.
 
     j. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect 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.

						XXXXXXXXXXXXXXXXXX
						Assistant General Counsel
						(Manpower & Reserve Affairs)