RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00745
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “asthma” and “post concussive syndrome,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI contends that the ratings for his headaches, asthma, high blood pressure and right knee should be changed.  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 - 20020129	VARD - 20040206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR	
Post Concussive Syndrome with Episodic Headaches and a History of Vertigo	8199-8100	0%	Post Concussive Syndrome with Episodic Headaches and a History of Vertigo	8045-8100	0%	STR	
Hypertension	Not Unfitting	Hypertension	7101	0%	STR	
Right Knee Pain	Not Unfitting	Right Knee Pain due to Retropatellar Pain Syndrome	5299-5024	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in February 2001 with symptoms of exertional shortness of breath and wheezing.  In May 2001, the CI had a “good bronchodilator response” on a pulmonary function test (PFT) which measured a FEV1 of 92% predicted and a FEVI/FVC of 86% predicted and was consistent with an asthma diagnosis.  A chest X-ray was normal.  He was placed on both daily use of inhaled corticosteroids and an inhaled bronchodilator on an as needed basis.  Despite restrictions and medications, the CI continued to have respiratory symptoms consistent with ‘mild persistent asthma’ for which he was referred for MEB.  The MEB NARSUM examination on 21 September 2001, 8 months prior to separation, indicated the CI doing very well with daily inhalational steroid use.  His respiratory focused physical examination (PE) was unremarkable.  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 since the CI “failed to report” for a scheduled examination on 24 September 2003.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing intermittent inhalation therapy.  The VA coded the condition the same and rated at 0% secondary to failure to report for examination.  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%.  Having clear reported evidence of the use of inhaled anti-inflammatory medication (Flovent) on the NARSUM examination easily 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.  

Post Concussive Syndrome with Episodic Headaches and a History of Vertigo.  According to STR and the MEB NARSUM, the CI struck his head against a metal bed frame in July 2000 which was associated with a “few seconds” of unconsciousness without seizure activity.  Since the initial event, the CI has had recurrent throbbing headaches associated with dizziness, vertigo, nausea and near fainting events.  Upon completion of a complete work-up from Internal Medicine and Neurology, the CI was diagnosed with post concussive syndrome.  The MEB forwarded “post concussive syndrome”, “episodic vertigo”, and “episodic headaches,” for PEB adjudication.  At the MEB NARSUM examination on 21 September 2001, 8 months prior to separation, the CI’s chief complaint was listed as “headaches after fall and trauma to the head”.  The PE revealed no somatic abnormalities.  The primary diagnosis remained as post concussive syndrome with the headaches and vertigo as being secondary to the primary condition.  An MEB addendum dated 02 January 2002, 4 months prior to separation, indicated that the CI’s daily headaches “…have not significantly impaired his ability to perform his limited duties that he has been assigned”.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the post-concussive syndrome at 0% analogously coded as 8199-8100 (migraines).  The VA also rated the same condition at 0% utilizing a dual code of 8045-8100 (migraines as a residual of traumatic brain injury [TBI]), based on the STR.  The Board adjudged that the headaches symptoms in this case were appropriately considered under the 8100 VASRD coding scheme.  The VASRD §4.124a rating schedule for 8100 (migraine) rests heavily on the frequency of “characteristic prostrating attacks … over last several months.”  The rating options under 8100 rely on the frequency and severity of ‘prostrating’ attacks.  The Board deliberated on the parameters of the “prostrating” definition in relation to this condition.  The Board carefully considered the comment on the MEB addendum in regards to the headaches not interfering with the CI’s limited duties as evidence of not supporting the prostrating criterion under 8100.  Under VASRD guidance, absent evidence of prostration provides no positive impairment rating.  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 adjudication for the post concussive syndrome condition.  

Contended PEB Conditions:  Hypertension and Right Knee Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the above listed contended conditions were not unfitting.  The right knee pain was profiled but neither condition was implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance near the time of separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the post concussive syndrome condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension and right knee pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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%	
Post Concussive Syndrome 	8199-8100	0%	
COMBINED	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, AR20170000259 (PD201500745)

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