RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01263
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tanker, medically separated for “reactive airway disease evaluated analogous to bronchial asthma” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20091016	VARD - 20100408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease…	6699-6602	0%	Reactive Airway Disease	6699-6602	0%	20100303	
Shin Splints	Not Unfitting	Bilateral Shin Splints	5299-5262	0%	20100303	
History of Kidney Stones	Not Unfitting 	Nephrolithiasis	7508	0%	20100303	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Reactive Airway Disease (RAD).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in July 2008 for a recent history of recurrent shortness of breath with exertion.  Pulmonary function testing performed on 22 September 2008 showed normal spirometry, but with a post-bronchodilator increase in forced expiratory volume at one second (FEV1) of 11% which is consistent with RAD.  The CI was started on an inhalational anti-inflammatory inhaler (Advair 500/50) twice daily and a bronchodilator inhaler (Alupent) as needed.  At an allergy evaluation on 26 February 2009 the specialist noted the CI tested positive for mold allergy and his respiratory symptoms had started immediately following a change of duty station from a dry climate.  The allergist expected the CI to continue to improve and that he “may gradually wean meds according to symptoms,” but suggested that the CI remain on his anti-inflammatory inhaler “for now.” On 9 April 2009, approximately 8 months prior to separation, the pre-bronchodilator pulmonary function test was normal with a 6 percent increase in FEV1 following bronchodilator medication.  There was no evidence in the STR that RAD exacerbations were frequent enough to require monthly visits to a physician or required at least three courses of systemic corticosteroids in the past year.  

The 29 June 2009 MEB NARSUM examination, 6 months prior to separation, noted that the CI was taking an anti-inflammatory inhaler and a bronchodilator inhaler as needed.  The physical examination of the lungs was normal.  The examiner noted concern of possible functional limitations if the CI went into a high particulate environment or a high temperature environment.  The 20 August 2009 Internal Medicine addendum to the MEB, 4 months before separation, indicated that there was no need for either a cardiology evaluation or gastroenterology consult to evaluate for gastroesophageal reflux. 

At the 3 March 2010 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the examiner noted that the CI was taking an anti-inflammatory inhaler twice daily and bronchodilator inhaler as needed.  The physical examination of the lungs was normal with no evidence of abnormal breath sounds.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the RAD condition 0%, coded analogously to 6602 (asthma, bronchial).  The VA also rated the RAD condition 0% coded 6699-6602, based on the VA examination approximately 3 months after separation, citing intermittent inhalational or oral bronchodilator therapy.  

A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Panel members considered that the CI was diagnosed with RAD with a pre-treatment PFT consistent with RAD and the MEB NARSUM and C&P examinations reported current prescription and use or daily use of an anti-inflammatory inhaler.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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 or PFT evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the reactive airway disease condition, coded 6699-6602.  

Contended PEB Conditions:  Shin Splints, “History of Kidney Stones.”  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The shin splints condition was profiled, but the kidney stone condition was not.  Neither condition was identified or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the reactive airway disease condition, the panel unanimously recommends a disability rating of 30%, coded 6699-6602 IAW VASRD §4.97.  In the matter of the contended shin splints and “history of kidney stones” conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Reactive Airway Disease…	6699-6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007536 , XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the XXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					       
Enclosure