RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00191
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Abrams Tank System Mechanic, medically separated for “reactive airway disease, exercise induced,” with a disability rating of 0%.

CI CONTENTION:  His back and asthma conditions continue to worsen and impact his daily activities.  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 - 20030609	VARD - 20031010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease	6699-6602	0%	Reactive Airway Disease with Moderate Persistent Asthma	6699-6602	10%	20030715	
Spondylolysis 	Not Unfitting	Bilateral Spondylolysis	5010	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Reactive Airway Disease, Exercise Induced.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in July 1997 with difficulty breathing after exercise.  He was treated with inhalers and his episodes of shortness of breath increased in 2001 with increased physical activity and increased activity related to his military specialty.  In June 2001, his recurrent coughing, wheezing, and shortness of breath led to evaluation for possible asthma.  Although initial pulmonary function tests (PFT) were normal, provocation testing (methacholine challenge) confirmed the presence of reversible airway obstruction consistent with the diagnosis of asthma.
The MEB addendum dated 20 March 2003, documented normal PFTs without medication (FEV1-99% and FVC-99%).  The pulmonologist diagnosed seasonal allergic rhinitis and exercise bronchospasm by history, “but no evidence or history of asthma per se.”  During the NARSUM examination on 1 May 2003, 5 months prior to separation, the CI reported he was taking albuterol as needed with increased activity.   

Review of the STR showed six separate clinical encounters in evidence documenting the use of an oral (inhaled) or parenteral steroid for asthma during the year prior to separation.  However, in the 6 months before separation, there was no evidence of daily use of any asthma medication, nor any need for parenteral steroids.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.   

At the 15 July 2003 VA Compensation and Pension (C&P) evaluation, 3 months prior to separation, the examiner noted that the CI was using albuterol (inhaled bronchodilator).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6699-6602 (asthma, bronchial), citing last medication obtained in December 2002.  The VA rated the asthma condition 10%, coded 6699-6602, citing the need for intermittent inhalational therapy.  The 10% rating stipulates “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.”  The PFT results in this case showed an FEV-1 greater than 80 percent predicted and an FEV-1/FVC greater than 80 percent; however, the CI reported intermittent use of a rescue bronchodilator (inhaled).  Therefore, a 10% rating but no higher was supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the asthma condition, coded 6602.  

Contended PEB Conditions:  Spondylolysis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the reactive airway disease, exercise induced condition, the Board recommends a disability rating of 10%, coded 6602 IAW VASRD §4.71a.  In the matter of the contended spondylolysis condition, the Board unanimously or majority recommends no change from the PEB determinations as not unfitting.  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, effective as of the date of the prior medical separation.

CONDITION	VASRD CODE	PERMANENT RATING	
Reactive Airway Disease, Exercise Induced	6602	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150220, 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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018513 (PD201500191)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

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.   

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:

CF: 
(  ) DoD PDBR
(  ) DVA