RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00660
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “exercise induced dyspnea without criteria for asthma” with a disability rating of 10%.  

CI CONTENTION:  The CI request review of application for retirement vs severance pay.  She contends for a back condition which is not within this Boards purview and is addressed in SCOPE OF REVIEW below.  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 - 20040726	VARD - 20050429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Dyspnea without Criteria for Asthma	6699-6602	10%	Asthma	6602	0%	20041215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Exercise Induced Dyspnea (shortness of breath).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s respiratory condition began in June 2001 after experiencing dyspnea on a 2-mile run as part of a physical fitness test.  A complete pulmonary work-up to include intensive diagnostic tests did not reveal a definitive respiratory diagnosis.  Despite a normal evaluation, her exercise-driven symptoms remained.  The MEB forwarded “exercise intolerance due to dyspnea without objective evidence of asthma,” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated April 2004, 4 months prior to separation, the provider noted “asthma” as a diagnosis; however, it appears that was documented and deemed appropriate based solely on the reported history from the CI rather than from diagnostic clinical data.  Her physical examination (PE) was documented as normal.  At the MEB NARSUM examination on 19 May 2004, 3 months prior to separation, the CI’s chief complaint was “asthma”.  The examiner provided the CI’s historical clinical summary specifically noting her “normal” findings.  Her latest pulmonary function tests (PFTs) were performed 1 week prior to the NARSUM.  The CI also stated that past medications taken by her (albuterol [bronchodilator], Flovent [inhaled corticosteroid], Serevent, and Singulair) have helped her breath better, but do not totally resolve her symptoms.  Radiographic studies of the chest and lungs were normal.  Her PE was normal.  At the 15 December 2004 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported adverse respiratory symptoms with increased activities or working in warm summer months.  She reported current and daily use of albuterol, Flovent and Singulair. Her PE as well as repeat PFT’s were normal.  The examiner documented the CI’s condition as “asthma, currently controlled with medication; pending PFT tests and chest X-ray”.  Later documentation revealed both the PFT and chest x-ray were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the “exercise induced dyspnea without criteria for asthma” condition 10%, coded 6699-6602 (analogous to asthma, bronchial), citing dyspnea on exertion.  The VA coded the condition as asthma and rated 0% based on the C&P examination 4 months after separation, citing a non-compensable evaluation.  Having no actual diagnosis of asthma (despite extensive clinical tests), all Board members first agreed that the associated symptoms were most appropriately captured under the analogous coding as utilized by the PEB.  The VASRD Guidelines under the 6602 code makes a special note that states the following: “In the absence of clinical findings of asthma at the time of examination, a verified history of asthma attacks must be of record.”  This case clearly had the persistent “absence of clinical findings of asthma” and never had any verification of historical asthma attacks recorded in the STR.  Therefore, Board members concluded that despite taking medication frequently used for an asthma condition, this case, by the special VASRD note would not support a positive impairment rating.  IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  Therefore, 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 adjudication for the respiratory condition.  

BOARD FINDINGS:  In the matter of the “exercise induced dyspnea without criteria for asthma condition,” 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, 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, AR20170000792 (PD201500660)

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