RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00280
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20000801	
DATE REMOVED FROM TDRL:  20020820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Chemical Operations Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.

CI CONTENTION:  The VA rated her higher than the Army and her condition continues to worsen and impact her daily life.  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 – 20000801/20020807	VARD - 20010817	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6699-6602	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 (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in January 1997 while performing physical training.  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 “exercise induced asthma,” for PEB adjudication.  
During the MEB examination dated 9 November 1999, 33 months prior to separation, the CI reported having 3 to 4 episodes of acute exercise induced asthma treated with Azmacort and Proventil nebulizers.  Review of the STR showed 5 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 STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  The CI was separated from active duty and placed on TDRL with a disability rating of 30% on 1 August 2000.  At the 28 November 2000 VA Compensation and Pension (C&P) evaluation 21 months prior to TDRL removal and permanent separation, the examiner noted that the CI was taking Proventil, AeroBid, and Azmacort inhalers.  During the TDRL period, review of the STR showed 2 separate clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to removal from the TDRL.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  At a VA pulmonary clinic evaluation dated 3 April 2002 the CI reported continued shortness of breath with exertion.  She reported that walked 2 miles, 3 times a week, and used her inhaler prior to and after her workouts.  The examiner noted her medications as albuterol as needed.  The post-bronchodilator pulmonary function tests (PFT) in evidence which the Board weighed in arriving at its rating recommendation were normal.  A pre-bronchodilator cardiopulmonary test performed 3 months prior to separation was abnormal (FEV1 67%) with a post-bronchodilator evaluation not performed.  

The Board first considered its rating recommendation at the time of placement on TDRL.  The PEB rated the asthma condition 30%, coded 6602, citing the requirement to take daily inhaled medications.  The VA rated the asthma condition 30%, coded 6602, citing a forced expiratory volume in one second (FEV-1) of 56-70 percent of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 56-70 percent; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.  Board members agreed that the evidence supports a TDRL placement rating of 30%.  The Board next considered its recommendation for permanent disability rating at the time of removal from the TDRL.  The CI was removed from TDRL with a permanent disability disposition at separation with severance pay at 10%.  There was no satisfactory evidence of post-bronchodilator PFT, daily inhalational or oral bronchodilator therapy, or of inhalational anti-inflammatory medication use at the time of removal from the TDRL, to justify the next higher 30% rating.  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’s TDRL placement and removal 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 adjudication.  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 20150317, with 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

07 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002590  (PD201500280)

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