RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04177
BRANCH OF SERVICE:  Army 	Separation date:  20051015
DATE PLACED ON TDRL:  20051016	DATE REMOVED FROM TDRL:  20101015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cable Systems Installer, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” rated 10%.

CI CONTENTION:  The CI contends a higher rating for his unfitting condition.  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 – 20050816/20101228	VARD - 20101103	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma…	6602	30%	10%	Asthma	6602	0%	10%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in March 2004 for a new onset, recurrent, exertional shortness of breath and exercise intolerance which began while he was deployed.  A diagnosis of exercise induced asthma was made based on clinical presentation.  An inhaled bronchodilator (Albuterol) was prescribed on an “as needed” basis in March 2004, 19 months prior to separation, and an inhaled anti-inflammatory medication (Advair - a combination inhaled steroid/bronchodilator) was started in June 2004.  On 23 June 2004, 16 months prior to separation, pulmonary function testing (PFT) showed a pre-bronchodilator FEV-1 at 72% of predicted and an FEV-1/FVC of 73%.  A second PFT performed on 15 July 2005, showed PFTs at FEV-1 at 76%, with FEV-1/FVC at 78%.  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 referred for an MEB.  The MEB forwarded “asthma” for PEB adjudication.  

During the MEB examination (recorded on DD Form 2807 Report of Medical History and DD FORM 2808 Report of Medical Examination) dated 2 August 2005, 2 months prior to placement on the TDRL, the CI reported taking those same two medications (Albuterol and Advair).  Other medications had apparently been prescribed in the interim but discontinued due to ineffectiveness.  The MEB NARSUM dated 8 August 2005 noted the CI continued “daily inhalational steroids…inhalers prior to physical training…albuterol for rescue needs.”  Review of the STR found 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.  

The VA did not perform a Compensation and Pension (C&P) evaluation proximate to placement on the TDRL.  The TDRL removal examiner on 27 September 2010 documented daily inhalational anti-inflammatory medication (Mometasone Furoate), daily bronchodilator (Ipratropium Bromide), and as needed steroid inhaler (Albuterol).  The lung examination was normal.  The examiner referenced a same day PFT which demonstrated “moderately severe obstruction.”  At a VA C&P examination dated 8 October 2010 the CI reported daily wheezing, shortness of breath with severe exertion, several clinic visits per year for exacerbations, and one acute attack per year.  On physical examination there was left side wheezing.  The examiner noted disease regression and daily inhaled bronchodilator and anti-inflammatory medication.

The Board first considered its rating recommendation for placement on the TDRL based on the above evidence.  The CI was separated and placed on TDRL with a disability rating of 30%, coded 6602 (asthma), citing use of inhaled corticosteroids (inhalational anti-inflammatory medication).  On 6 June 2006 the VA rated the asthma condition 0% using the same 6602 code, citing that the CI failed to report for a VA examination thus a lack of current evidence to support the disability claim.  Board members considered that the examinations in evidence for placement on the TDRL reported prescription and use of inhaled anti-inflammatories.  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 medication use.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, intermittent (at least three per year) courses of systemic corticosteroids or PFT evidence raising to that level. The Board next considered its recommendation for permanent disability rating at the time of removal from the TDRL. The PEB rated the asthma condition at 10% at TDRL removal citing “lack of clinical evidence of inhaled steroid use in the 18 months preceding the TDRL examination.” The Board noted that on 27 September 2010, the TDRL examiner indicated current medication included daily inhalational anti-inflammatory medication (Mometasone Furoate), daily bronchodilator (Ipratropium Bromide), and as needed steroid inhaler (Albuterol).

The VA C&P examination performed 8 October 2010 noted daily use of both inhaled bronchodilator (Albuterol) and anti-inflammatory medication (Advair).  A PFT performed for this C&P examination revealed FEV-1 at 81% of predicted value and FEV-1/FVC of 74%; however, the PFTs were not interpreted because it did not meet criteria for acceptability.  A 3 November 2011 VA Rating Decision documented a rating of 10% for the asthma condition citing the higher of two evaluations based on the wheezing on examination and an FEV-1/FVC within 1% of the predicted criteria for 10%.  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 medication and daily inhalational bronchodilator therapy.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, intermittent (at least three per year) courses of systemic corticosteroids or PFT evidence raising to that level.  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 for both placement on and removal from the TDRL, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a TDRL placement and TDRL removal 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	RATING	
		TDRL	PERMANENT	
Asthma	6602	30%	30%	

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 AR20160013331 (PD201404177)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA