RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01045
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041101

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

CI CONTENTION:  The CI indicates he has difficulty with his knees, elbow (right or left unidentified) and back.  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 on 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 – 20030527/20040916	VARD - 20030804	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	10%	Asthma	6602	30%	30%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had asthma prior to service, but did not come to medical attention until August 2002 when he reported chest pain with exercise.  He was found to have symptoms consistent with exercise induced asthma during the evaluation.  Pulmonary function tests (PFTs) in early September showed a slight obstruction (consistent with mild asthma), but no significant change with a bronchodilator (as would be expected with asthma).  A methacholine challenge was positive for asthma.  The CI was begun on medications, but was not able to meet full duty requirements at the end of the 6-month trial.  It was noted that he continued to smoke a pack per day.  He was then referred for MEB.  The MEB NARSUM was dated 23 April 2003, 4 months prior to TDRL placement.  Despite medications including inhaled steroids, the CI remained unable to meet full duty requirements including running and the use of a face mask.  On examination, his lungs were clear and he was in no respiratory distress.  The PFTs are charted below.  At the VA Compensation and Pension (C&P) examination performed on 23 June 2003, 1 month before placement on TDRL, the CI reported continued problems despite treatment.  On examination, the lungs were clear and a chest X-ray was normal.  The CI was then placed on TDRL effective 23 July 2003.  The CI underwent a TDRL examination on 4 August 2004.  He reported no exacerbations for the last year and his symptoms had improved.  Despite continued smoking, he had stopped the inhaled steroids without a significant adverse effect and used the bronchodilator only as needed.  On examination, his lungs were clear and PFTs normal as charted below.  The pulmonologist changed the description of the asthma from moderate persistent to mild intermittent.  The PFTs in evidence, which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.  

Pulmonary Exam	Pulmo ~3 Mo. Pre-TDRL Placement	Pulmo ~2 Months before TDRL Removal	
FEV1 (% Predicted)	95	90%	
FEV1/FVC	82	81%	
Meds	Daily medications	Inhaled broncho-dilator as needed	
§4.97 Rating	30%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated asthma condition at 30% for TDRL placement and 10% at TDRL removal.  The VA rated the asthma condition at 30% shortly after TDRL placement.  Both coded the condition 6602 (asthma).  The CI did not report for a scheduled follow on examination by the VA and his rating was subsequently reduced to 0% in 2006, but later raised back to 10% in 2009 after a follow-up examination.  The PFTs were essentially normal and do not support a compensable rating.  The medications used support a 30% rating (daily use) at TDRL placement and 10% (bronchodilator as needed) at TDRL removal.  No route to a higher rating was found.  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.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.100, 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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011794, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,