RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00730
BRANCH OF SERVICE:  Army
DATE PLACED ON TDRL:  20050129
DATE REMOVED FROM TDRL:  20070816

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

CI CONTENTION:  “Major secondary injury due to primary injury was put out of the military for asthma?  Put on several meds that caused hip replacement” 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 – 20041222/20070720	VARD - 20050617	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	Asthma	6602	0%	0%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began after March 2004 during a deployment to Iraq.  The CI experienced persistent shortness of breath, wheezing and chest tightness in response to rising temperatures in theater.  He was medically evacuated from Iraq, eventually returning to CONUS where his symptoms persisted.  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.  

At the 13 October 2004 pulmonary clinic examination, 3 months prior to being placed on TDRL, the examiner documented no significant change in the CI’s symptoms of shortness of breath, wheezing and chest tightness, despite treatment with Advair (an inhalational anti-inflammatory medication in the form of inhalational steroid/bronchodilator combination) twice daily and Albuterol (bronchodilator therapy) as needed.  

The MEB NARSUM examination on 6 December 2004, 2 months prior to TDRL placement, noted that the CI was taking Advair twice daily and albuterol on an as needed basis.  The CI continued to have persistent symptoms of wheezing, shortness of breath and chest tightness despite ongoing medication therapy.  The CI’s condition interfered with his ability to function in a deployed environment.  Review of the STR found no 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 during the year prior to separation.  

At the 19 April 2005 VA Compensation and Pension (C&P) respiratory system and General Medical evaluation, 4 months after placement on TDRL, the CI was taking Albuterol, two puffs as needed, three or four times per day.  The examiner recorded the CI was no longer taking Advair and that he routinely used Albuterol as stated above.  The May 2005 pulmonary function test PFT) recorded FEV1 at 96% predicted and FEV1/FVC at 72% pre bronchodilation.  At the 10 August 2006 primary care clinic examination, 19 months after TDRL placement and 12 months prior to TDRL removal, the CI reported minimal symptoms.  He was using Albuterol 2-3 times per month.  Heat brought on his symptoms.  The CI denied difficulty breathing on exertion, cough or waking up due to cough.  

The TDRL evaluation NARSUM examination on 19 April 2007, 4 months prior to TDRL removal, noted the CI had no hospitalizations, nor any emergency room visits for his asthma condition since being placed on TDRL.  In August 2006, the CI discontinued using Advair due to subjective tightness in his chest.  The CI continued using Albuterol inhaler on an as-needed basis, with an approximate reported use frequency of once per day, especially in the morning.  Running or any sustained physical exertion triggered the asthma.  Hot and humid days further exacerbated this condition.  The examiner noted that the CI required no oral steroid medication since being placed on the TDRL.  The CI reported no significant change in his asthma symptoms over the past 2 years.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the period of TDRL.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician during the period of TDRL.  

The Board directed attention to its rating recommendation based on the above evidence. Upon TDRL placement, the PEB rated the asthma condition 30%, coded 6602 (asthma, bronchial), citing use of daily inhalational therapy.  Upon TDRL removal, the PEB rated the asthma condition 10% under code 6602 (asthma, bronchial) citing the CI being “on an intermittent inhalational bronchodilator”.  

The VA rated the asthma condition 0% coded 6602 (asthma, bronchial), based on the VA C&P examination 4 months after TDRL placement, citing pulmonary function test values of FEV-1 at 96%.  The VA specifically cited a noncompensable evaluation was assigned as the CI did not meet the next rating level (10%) which equated to FEV-1 of 71-80 percent, or FEV-1/FVC of 71 to 80 percent, or intermittent use of inhalational or oral bronchodilator therapy.  A subsequent VA rating decision on 28 December 2007, 5 months after TDRL removal, continued the 0% non-compensable rating for the CI’s asthma condition, citing that the CI failed to report for a scheduled pulmonary function test as had been previously scheduled to support this rating.  

TDRL Placement Rating.  A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.” Board members considered that the pulmonary and MEB NARSUM examinations in evidence reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed and used, as noted by the pulmonary and MEB NARSUM examiners.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or inhalational anti-inflammatory medication use.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% 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 adjudication for the asthma condition upon TDRL placement.  

TDRL Removal Rating.  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 83 percent predicted and the FEV-1/FVC of 75 percent 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 adjudication for the asthma condition upon TDRL removal.  

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 20150603, 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 
XXXXXXXXXXXXXXXXXX, AR20170000448 (PD201500730)

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