RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01338
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050308

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

CI CONTENTION:  His condition should have been rated higher.  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 - 20050114	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease	6699-6602	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Reactive Airway Disease (RAD).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sought medical treatment for shortness of breath after a field exercise in July 2003.  He was hospitalized for a brief time for an exacerbation of allergic bronchial asthma.  Despite aggressive treatment of his allergies and asthma with allergy medications, an anti-inflammatory inhaler (Advair) and a bronchodilator inhaler (albuterol) the CI continued to have symptoms with exertion or exposure to dust.  Although pulmonary function testing was not diagnostic, a methacholine challenge test performed on 29 September 2003, 18 months prior to separation, was positive, consistent with a diagnosis of asthma.  According to the 21 January 2004 internal medicine clinic evaluation, 14 months prior to separation, the examiner noted that the CI was on daily inhalational anti-inflammatory medication and a bronchodilator rescue inhaler as needed.  The CI had improved with medication usage and was able to pass his physical fitness (PT) test but used an inhaler during the run.  A P2 profile for asthma was written and the medications were filled for deployment.  However, the CI did not deploy due to worsening of his allergy and asthma symptoms.  At the August 2004 internal medicine clinic visit, 7 months before separation, the CI reported using his anti-inflammatory inhaler once per day and not twice daily as he had been advised.  At the October 2004 internal medicine clinic visit, 5 months before separation, the CI reported that, despite use of an anti-inflammatory inhaler twice daily and increased medication for allergies, he used his rescue inhaler up to six times per day during physical training and during work in heavy dust areas.  He still reported chest tightness and wheezing with running.  The assessment was “allergy triggered RAD.”  The CI brought in empty medication bottles and current medications to help document compliance.  However, the last refill of his anti-inflammatory inhaler with him was February 2004, bottles of oral bronchodilator medication were all from 2003, and he did not bring in a bronchodilator inhaler.  The examiner noted the CI was unable to pass the 2-mile run during allergy season after a year of “good medical tx.”  Review of the STR did not show treatment with systemic steroids or at least monthly visits to a physician for required care of exacerbations.  

The 19 October 2004 MEB NARSUM examination, 5 months before separation, noted complaints of RAD with allergy triggers.  The CI ‘s medications were an anti-inflammatory inhaler twice daily, a bronchodilator inhaler as needed, and oral bronchodilator medication daily, as well as other medications for allergies.  Physical examination of the heart and lungs was normal.  There was no VA Compensation and Pension examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the RAD condition 0%, coded analogously 6699-6602 (asthma), citing non-compliance.
While non-compliance with generally acceptable medical standards of care can affect the severity of a ratable condition, once a condition is determined to be unfitting, the panel must rate the condition IAW VASRD guidelines. The VASRD rating criteria for the RAD condition do not incorporate non-compliance as a deduction for rating.  

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.”  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed, as noted by the Internal medicine and NARSUM examiners.  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.  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 panel recommends a disability rating of 30% for the RAD condition, coded 6699-6602

BOARD FINDINGS:  In the matter of the RAD condition, the panel unanimously recommends a disability rating of 30%, coded 6699-6602 IAW VASRD §4.97.  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	
RAD	6699-6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record

AR20170009084, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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