RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04335
BRANCH OF SERVICE:  Army 
DATE PLACED ON TDRL:  20020611	DATE REMOVED FROM TDRL:  20041122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Early Warning System Operator, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” with a disability rating of 0%.  

CI CONTENTION:  The CI requested that all conditions be considered.  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 on 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 – 20020315/20040729	VARD - 20021029	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	0%	Asthma	6602	30%	30%	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in June 2001 for a recent history of recurrent shortness of breath and wheezing associated with exercise.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  On 22 June 2001, PFT revealed FEV-1 at 101% of predicted value, and FEV-1/FVC at 84%.  Inhaled bronchodilator medication (albuterol) was prescribed on an “as needed” basis in July.  At a pulmonology appointment in August 2001, the CI was additionally prescribed an inhaled anti-inflammatory medication (Advair) along with Singulair (an oral indirect-acting bronchodilator).  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, moderate persistent” for PEB adjudication.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 October 2001, 8 months prior to placement on the TDRL, the CI reported taking those same three medications (Albuterol, Advair and Singulair).  The MEB NARSUM examination on 22 January 2002 (5 months prior to placement on TDRL) noted the CI continued using the same three medications, with the Albuterol (inhaled bronchodilator) being taken 3 times per day.  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 CI was separated and placed on TDRL with a disability rating of 30%, coded 6602, citing “regular inhalational medication.”  

At the VA Compensation and Pension (C&P) evaluation on 8 October 2002, 4 months after placement on the TDRL, the CI reported that he continued to take the same three medications listed above (Albuterol, Advair, and Singulair).  PFT performed that day revealed FEV-1 at 86% of predicted value, with FEV-1/FVC at 82%.  On 29 October 2002 the VA rated the asthma condition 30% (using the same 6602 code), citing the CI’s daily use of Advair.  

The TDRL evaluation on 15 April 2004 (7 months prior to removal from the TDRL) noted the CI had not refilled his asthma medications since January 2003, and had not sought medical care for asthma since that time.  The CI reported that he had been doing well without medications, and was taking no medications at the time of the examination.  Pulmonary examination was normal and PFT performed on 13 April 2004 had FEV-1 and FEV-1/FVC values above 80% (normal).  The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 0%, with the PEB citing “normal spirometry, not requiring medication.”  The VA has continued to rate the asthma disability at 30% at least through November 2014, with no updated C&P examinations or treatment notes for any pulmonary condition in the available evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The Board first considered its rating recommendation for placement on the TDRL based on the above evidence.  Board members considered that the examinations in evidence for placement on the TDRL reported then-current prescription and use of inhaled anti-inflammatories (which are not specified as a daily requirement under the 30% rating provision) as noted by the pulmonology, MEB, NARSUM and VA examinations.  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, or intermittent (at least three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% rating.  

The Board next considered its recommendation for permanent disability rating at the time of removal from the TDRL.  The CI was reported to be taking no medications for asthma at the time of the TDRL evaluation (7 months prior to TDRL removal), and there was no evidence in the record that the CI was taking any asthma medication proximate to exit from TDRL.  PFT results proximate to separation did not support a 10% rating (FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent).  Accordingly, the Board determined the appropriate rating recommendation for removal from the TDRL should be 0%, as the PEB assigned.  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 §4.97, the Board unanimously recommends no change in the PEB adjudications for TDRL placement or TDRL removal.  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/attachments
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 AR20160011619 (PD201404335)

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