RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04251
BRANCH OF SERVICE:  Army 
DATE PLACED ON TDRL:  20020507
DATE REMOVED FROM TDRL:  20030710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Combat Medic, medically separated from the Temporary Disability Retired List (TDRL) 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 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 – 20020321/20030627	VARD - 20020610	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	Asthma	6602	30%	30%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma began in 1993-1994 with breathing problems after running, which was treated with Azmacort (triamcinolone acetonide, an inhalational aerosol) and albuterol (a bronchodilator).  In June 2000, the CI was diagnosed with asthma with a baseline Pulmonary Functions Test (PFT) that showed FEV1 (forced expiratory volume at 1 second) of 78% predicted and FEV1/FVC (forced expiratory volume at 1 second/forced vital capacity) of 94% predicted. The impression of mild COPD (chronic obstructive pulmonary disease) with evidence of small airway reversibility marked by an increase in FEF 25/75 (forced expiratory flow between 25% and 75%) and flow volume loops supported the obstructive process.  Allergy evaluation in December 2001 did not reveal any positive responses to a wide variety of common allergens.

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 a Medical Evaluation Board (MEB).  The MEB forwarded “mild persistent asthma” for PEB adjudication.

At the MEB NARSUM examination dated 11 January 2002, 4 months prior to TDRL placement and 19 months prior to separation, the CI reported taking asthma medications Advair (fluticasone/salmeterol) and Singulair (montelukast) along with Chlor-Trimeton (chlorpheniramine maleate, an antihistamine), Flonase (fluticasone, a nasal steroid), multivitamins, and vitamin C.  Review of the STRs showed two separate 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 STRs that asthma exacerbations were frequent enough to require monthly visits to a physician.  

At the VA Compensation and Pension (C&P) evaluation on 26 February 2002 (16 months prior to separation) the examiner noted that the CI was taking Singulair and Chlor-Trimeton (both orally) and using Pulmicort (budesonide, an inhalation steroid), Serevent (salmeterol, a bronchodilator) and Proventil (albuterol, a bronchodilator), and Flonase.  

At the TDRL removal examination dated 7 May 2003 the CI stated he had approximately one to two asthma attacks monthly and symptoms six to seven times a month.  He continued taking Serevent, Proventil, Pulmicort and Flonase.  The examiner’s diagnosis was moderate persistent asthma and noted the CI’s condition had not changed significantly since his last evaluation in 2002.

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	MEB (TDRL Entry) ~4 Mo. Pre-TDRL
	VA C&P ~2 Mo. Pre-TDRL Entry and 16 Mo. Pre-TDRL Exit
	MEB (TDRL Exit)~3 Mo. Pre-Sep
	
FEV1 (% Predicted)	73.91%	72.75%	80% pre-drug/83% post-drug	
FEV1/FVC (% Predicted)	93.89%	91.45%	94% pre-drug/101 post-drug	
Meds	Not specified at the exam, but the record indicated Advair	Not specified at the exam, but the record indicated Pulmicort	Not specified at the exam, but the record indicated Pulmicort	
§4.97 Rating	10% on data;30% on medication	10% on data; VA 30% 	10% on data; 30% on medication	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 30% (coded 6602) citing the condition required daily inhaled medication.  The CI was placed on the TDRL for 16 months and upon TDRL removal the PEB rated the asthma condition 10% (coded 6602) citing FEV-1 80% and 83% after inhaled bronchodilator and on intermittent inhalational bronchodilator therapy.  The VA rated the asthma condition 30% (coded 6602) citing recurrent respiratory infections and shortness of breath with minimal exertion and requiring daily inhalational medications for the foreseeable future.  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.”  Board members considered that the MEB NARSUM and VA C&P examinations in evidence reported current prescription of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were also prescribed, as noted by the MEB NARSUM and VA C&P examiners.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or inhalational anti-inflammatory medication use or prescription.  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.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change to the disability rating of 30% for the asthma condition, coded 6602 for TDRL placement and a disability rating of 30% for the asthma condition, coded 6602 for TDRL removal.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97 for TDRL placement and a disability rating of 30%, coded 6602 IAW VASRD §4.97 for TDRL removal.  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	
		PERMANENT	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141008, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB																		

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 XXXXXXXXXXXXXXXXXXXXX, AR20160018308 (PD201404251)

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