RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04046
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Cryptologic Communications, medically separated by the Informal Physical Evaluation Board (PEB) for “asthma,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20051025	VARD - 20060718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	10%	20060621	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Asthma.  The record shows that the CI denied a history of asthma at accession.  There is no record of a breathing disorder during basic and advanced infantry training.  In October 2004, he reported abdominal pain and was found to have a mass in his chest on CT scan.  This was subsequently removed surgically.  Following surgery, he was evaluated in the emergency room for persistent chest pain on 12 and 16 January 2005.  A repeat chest CT showed expected post-operative changes and the physical examination was notable for chest wall pain.  Notably, he denied any respiratory symptoms and the pulmonary examination was normal.  He was advised to follow up in primary care.  The next record in evidence is an evaluation on 26 January 2005 by a pulmonologist for shortness of breath, cough, and sputum production.  The CI reported a 2 month history of left sided chest wall pain and shortness of breath with exertion.  He was noted to be a very poor historian.  On 2 February 2005, pulmonary function tests (PFTs) were normal before and after bronchodilators.  Two weeks later, the PFTs remained normal.  Provocative testing with methacholine was positive on testing and reproduced his symptoms.  These changes were largely reversed with a bronchodilator.  On follow-up in pulmonary medicine on 25 February 2005, he was again noted to be a very poor historian.  His lungs were clear.  A diagnosis of presumptive asthma was made and he was prescribed daily inhaled steroid and a rescue bronchodilator (one to be used for break-through symptoms).  When seen 2 weeks later, he reported improvement in his cough, but otherwise his symptoms were “basically unchanged.”  His lungs were clear.  The examiner noted “I am not sure how much of the CI’s symptoms are attempts at secondary gain versus poorly controlled asthma.”  The CI filled a prescription for Singulair on 8 March 2005.  On peak flow measurement, which should be relatively consistent, his values ranged from 250-600.  The examiner also wrote “I certainly do not believe his peak flows.”  On 12 April 2005, the CI was again evaluated in pulmonary medicine and it was noted that it was extremely difficult to communicate with the CI.  He answered questions in monosyllables and “is not a very reliable historian.”  He denied wheezing or nocturnal symptoms.  He endorsed use of Singulair (a prophylactic medication) and Advair (an inhaled steroid), but had stopped the use of albuterol (a bronchodilator).  His lungs were clear.  It was thought that he was not having significant bronchospasm; continuation of the current drug regimen was advised.  No further follow was advised due to the communication difficulties.  The MEB 2808 and 2807 were accomplished 25 May 2005.  The CI reported that he used Advair, Singulair, and Albuterol.  On examination, his lungs were clear.  A review of the medication history dated 7 September 2005 showed that the CI filled a prescription for Singulair (30 day supply) on 8 March 2005 as noted above.  No refills were in evidence.  There was no record of either the albuterol or Advair ever being filled.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) was dated 22 September 2005 and updated on 20 October 2005.  It was noted that the CI remained symptomatic despite maximal therapy and that he was unable to perform even minimal military tasks.  It was also noted that malingering was a concern (raised by the civilian pulmonologist).  He had no difficulty with the activities of daily living.  He was noted to have normal breath sounds and a normal respiratory rate and was in no distress.  Wheezing was absent on forced expiration (an attempt to provoke wheezing).  PFTS were repeated and normal.  It was recorded that the CI reported the use of both Advair and albuterol.  The VA Compensation and Pension (C&P) evaluation was performed on 21 June 2006, 6 months after separation.  The examiner noted that the CI was taking an inhalational bronchodilator and inhalational anti-inflammatory with a fair to poor response, using the albuterol monthly. The CI attributed his symptoms to chest wall pain since his surgery.  On examination, the respiratory rate was normal.  His lungs were dull on the left (side of the surgery) and breathe sounds reduced.  The PFTs were normal.  At a mental health C&P examination on 5 October 2009, almost 4 years after separation, the CI reported that he took no medications.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the CI at 0% for asthma with normal spirometry, coded 6602 (asthma).  The VA rated the asthma condition at 10% and also coded it 6602.  The Board considered the evidence.  Review of the pharmacy records (from August 2004 to September 2005) shows that the CI filled a 30 day prescription for Singulair in March 2005, 10 months prior to separation.  There is no record that it was ever refilled or that the prescriptions for albuterol and Advair were ever filled.  Numerous other medications were filled during this period of time.  Despite this, the evidence shows that the CI was in no respiratory distress at separation with a normal respiratory rate, absent wheezing, and normal PFTs.  Although he reported respiratory limitations in military duties, he denied restrictions in the activities of daily living.  Other than after the provocative Methacholine challenge test, which appears to be the basis for the diagnosis of asthma, the CI did not show a significant response to broncho-dilators on PFTs.  There were no emergency room visits for asthma (only for chest wall pain) nor were there clinical visits for asthma other than routine follow-up after the initial evaluation for the chest wall pain.  The pulmonologist made the diagnosis of “presumptive asthma”, but never was quite sure what the etiology of the symptoms was.  The totality of evidence is that it is more likely than not the CI was not using medications at the time of separation yet still had a normal pulmonary examination.  A mental health C&P remote from separation indicated that he took no medications at all for any condition.  A joint C&P examination recorded the use of non-steroidal anti-inflammatory medications (NSAIDs, drugs like aspirin).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

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

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 AR20160013816 (PD201404046)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA