RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00487
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Abrams Armor Crewmember, medically separated for asthma, with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20031015	VARD - 20040312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	STRs	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of shortness of breath upon exertion since 1997.  In March 2003 (11 months prior to separation), he had a positive methacholine challenge test and objectively diagnosed with asthma.  He was placed on Advair™ (inhalational steroid/bronchodilator combination) for daily use.  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 “moderate persistent asthma” for PEB adjudication.  The MEB NARSUM examination on 9 April 2003, 10 months prior to separation, indicated the CI taking Advair on a daily basis and Albuterol as needed.  His respiratory focused physical examination was normal.  A review of the STR did not show evidence of a requirement for daily use of a systemic (oral or parenteral) high dose corticosteroid or immunosuppressive medication and his asthma exacerbations were not frequent enough to require monthly visits to a physician.  There was no VA Compensation and Pension (C&P) examination contained in the case file for the CI “failed to report” for a scheduled examination on 22 December 2003.  The single pulmonary function evaluation that was within timeframe of this review was conducted on 7 March 2003, 11 months prior to separation, and revealed an FEV1 of 124% and an FEV1/FVC of 106% after an accumulated dose of 4 puffs of a bronchodilator after the diagnostic methacholine challenge test.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing intermittent use of Advair and Albuterol (twice a month).  The VA rated the asthma condition 30%, coded 6602, citing STR evidence of requiring inhalational anti-inflammatory medication.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both spirometry derived criteria and clinical treatment criteria for rating under 6602.  Based solely on spirometry parameters the CI’s condition did not meet VASRD disability criteria.  However, the clinical treatment criteria underpinning any positive 6602 rating is the pivotal point for discussion in this case.  The non-spirometry derived criteria are: “intermittent inhalational or oral bronchodilator therapy” for 10%; and “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication” for 30%.  Evidence of the use of inhaled anti-inflammatory medication (Advair) on the NARSUM examination supported the 30% impairment level near the time of separation.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the CI’s medication use of inhaled corticosteroids supported the 30% impairment level. 

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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, AR20160018721 (PD201500487)

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