RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01379
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” with a disability rating of 0%.

CI CONTENTION:  The CI did not make a contention on the application.  The CI’s 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 panel 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 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 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 – 20021009/20031009	VARD - 20030522	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma…	6602	30%	0%	Asthma	6602	--	30%	
COMBINED RATING:  30% → 0%	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 was evaluated in June 2002 for a recent history of recurrent (exertional shortness of breath / wheezing / coughing / exercise intolerance).  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  

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 MEB.  The MEB forwarded “reactive airway disease with exercise induced bronchospasm,” for PEB adjudication.

The MEB NARSUM examination on 23 September 2002, 13 months prior to separation, noted that the CI was prescribed Serevent, Flovent, and Proventil for daily use and complained of shortness of breath and wheezing with aerobic activity.  He was not able to perform the aerobic event for the physical fitness test and was restricted from wearing a protective mask or being exposed to petroleum products, gasoline, smoke, or flames due to his respiratory condition.  The CI was placed on the TDRL on 9 October 2002, 12 months prior to separation.  At the 18 April 2003 VA Compensation and Pension (C&P) evaluation 6 months prior to separation), the examiner noted that the CI was taking Albuterol.

The MEB NARSUM examination on 28 August 2003, at TDRL removal noted the CI was prescribed Albuterol and Serevent for daily use and reported daily Albuterol use and Azmacort when “symptoms get bad”.  He complained of increased shortness of breath and cough, productive of a clear phlegm.  The symptoms seemed to be worse in the morning and with activity.  The CI changed his lifestyle to avoid the labored breathing.  He reported being able to do the same level of activity as when being placed on TDRL and also complained of allergic symptoms affecting his asthma.  Review of the STR showed two separate 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.  

The Board directed attention to its rating recommendation based on the above evidence.  At TDRL placement, the PEB rated the asthma condition 30%, coded 6602, citing positive Metacholine challenge requiring daily inhaled steroid use.  The VA rated the asthma condition 30% coded 6602, citing a daily inhaler use, based on a C&P examination conducted 18 April 2003.  At TDRL removal, the CI was reevaluated by a second PEB 9 October 2003, which rated the asthma condition 0%, coded 6602, citing pharmacy records indicating the CI had not been regularly using medications and was removed from the TDRL and separated from the military.  

The next higher 10% rating stipulates “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.”  In this case, the CI reported only using Azmacort when his “symptoms get bad”, although Advair was recorded by the examiner in the hand written TDRL examination, as “using 1 puff twice a day,” and Albuterol as needed.  The PFT results in this case showed an FEV-1 greater than 80 percent predicted and an FEV-1/FVC greater than 80 percent.  Based on PFTs, the 10% is not supported.  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.”  

Board members considered that the VA C&P and MEB NARSUM TDRL removal examinations in evidence reported current prescription of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed, as noted by the medication profile.  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 prescription.  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 recommends a permanent disability rating of 30% for the asthma condition, coded 6602.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97, at TDRL removal.  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	RATING	
		PERMANENT	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011804, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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 U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure