RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04060
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “asthma,” with a disability rating of 10%.

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 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 - 20070323	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20070605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s asthma condition began in November 2005 while in Kuwait, where he developed shortness of breath with running.  The CI was evaluated in February 2006 for a history of recurrent shortness of breath.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  Inhaled bronchodilator medication (Advair) was prescribed on an “as needed” basis and inhaled steroid (Albuterol) was started in January 2006.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was aeromedical evacuated from Kuwait and referred for MEB.  The MEB forwarded “asthma” for PEB adjudication.  

According to the internal medicine evaluation on 22 May 2006, 14 months prior to separation, the examiner noted that the CI had normal respiration rhythm and depth without bronchial breath sounds, wheezing or rhonchi.  Later that day at the pulmonary clinic the examiner noted a normal spirometry; however, the examination was not in the record.  According to the psychiatry examination the following day, 23 May 2006, the examiner noted that the CI was found not to have asthma and was diagnosed with hyperventilation syndrome.  On 24 May 2005 the CI was seen at the internal medicine clinic for a follow up where the examiner noted that the CI had a negative PFT while symptomatic, so not likely that asthma explains current symptoms.  A methacholine challenge test performed 18 July 2006 was positive and confirmed the diagnosis of asthma.  At the MEB NARSUM examination on 15 February 2007, 5 months prior to separation, the CI disclosed that he was using only his rescue inhaler and the preventive medication (Advair).  The examiner recommended preventive medication use.  The examiner noted that at a primary care follow-up, the CI was taking Advair twice daily with predicted peak flow at 60% ( decreased air flow) prior to Albuterol.  The examiner noted that the focused pulmonary examination in October 2006 was “essentially normal” and that the CI was unable to pass the Army physical fitness test, but had passed the alternate walk event.  The examiner diagnosed the CI with asthma, moderate persistent.  At the 5 June 2006 VA Compensation and Pension (C&P) evaluation, 1 month prior to separation, the examiner noted that the CI was using an Albuterol inhaler 3 times a day. 

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the asthma condition 10%, coded 6602, citing a positive methacholine challenge test.  The VA rated the asthma condition 30%, coded 6602, citing use of inhalers.  Board members considered that the pulmonary, NARSUM/MEB, and VA C&P examinations all reported current prescription and use of daily inhaled anti-inflammatories and/or inhaled bronchodilators, which are not specified as a daily requirement under the 30% requirement, were also required and prescribed.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory and/or inhaled bronchodilator 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 3 per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% rating.  After due deliberation, and 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 recommends a disability rating of 30%, coded 6602 IAW VASRD §4.71a.  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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011799

Dear 

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,
(AHRC-DO), 

A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure
Sincerely,