RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00536
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20020517	
DATE REMOVED FROM TDRL:  20040512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Signals Analyst, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  

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 – 20020517/20031216	VARD 	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	No VA Examination in Evidence	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Asthma Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in April 2001 after he experienced shortness of breath, chest tightness, audible wheezing and cough on exercise.  The CI’s symptoms lasted approximately ½ to 1 hour after running.  He was prescribed an albuterol (inhalation bronchodilator) inhaler.
According to the narrative summary (NARSUM) a clinic appointment occurred in August 2001 (9 months prior to separation) at which time the CI reported his symptoms had become worse limiting his exercise.  In addition to the albuterol inhaler which had already been prescribed, Singulair (oral bronchodilator) 10 mg daily was added to his treatment plan.  Following the August clinic appointment, the CI’s symptoms continued and he was additionally prescribed an Advair (inhalation steroid/bronchodilator) Diskus inhaler.  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 “mild intermittent asthma, essentially exercise induced” for PEB adjudication.
 
The MEB NARSUM examination on 11 January 2002, 4 months prior to separation, noted the CI symptoms were unchanged and he reported he was unable to tolerate the Advair inhaler which he only used intermittently.  The CI denied symptoms at rest or at night, or when exposed to cats, dogs, dust, or mold.  Physical examination showed his chest was clear to auscultation bilaterally, no jugular vein distension (JVD) noted, and heart rate and rhythm were normal.  The treatment plan was updated and Azmacort (inhalation steroid) replaced the Advair inhaler.

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 Examination	Pulm ~9 Mos. Pre-Sep
	Pulm ~3 Mos. Pre-Sep
	Pulm ~18 Mos. Post-Sep
	
FEV1 (% Predicted)	100%	95%	90%	
FEV1/FVC	93%	92%	73%	
Meds	Inhaled Intermittent bronchodilator/oral bronchodilator/Inhaled steroid	Inhaled intermittent bronchodilator/inhaled steroid	Intermittent bronchodilator 	

The CI was separated and placed on Temporary Retirement Disability List (TDRL) with a disability rating of 30%.  According to the TDRL evaluation on 18 November 2003, 18 months after separation, the CI was asymptomatic.  He denied regular exercise or regular use of his Albuterol inhaler.  He reported no other medications.  Physical examination showed lungs clear on auscultation bilaterally, no wheezing or crackles, and heart rhythm and rate were normal.  Radiographic study showed no acute airspace disease, pneumothorax, or effusions.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 10%.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 30%, coded 6602 (asthma, bronchial), and placed the CI on the TDRL with the notation that the CI was on daily inhalational anti-inflammatory therapy  The CI did not submit a claim to the VA.  The Board found no evidence to support the higher rating of 60% (daily use of systemic steroids or immune-suppressive medications, or more than 1 attack per week with episodes of respiratory failure or FEV-1 less than 40% predicted or FEV-1/FVC less than 40%).  After due deliberation, in consideration of all 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 at TDRL placement.

At the time of permanent separation, the PEB rated the asthma condition 10%, coded 6602, citing FEV-1 90% after inhaled bronchodilator and on intermittent inhalational bronchodilator therapy.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Board members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the TDRL evaluation.  A 10% rating was also justified by FEV-1 of 90 percent predicted noted by the TDRL examination. 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 adjudications for the asthma at TDRL placement and TDRL removal.

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication at both TDRL placement and 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018746 (PD201500536)

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