RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01404
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Marine Recruit, medically separated for “fixed expiratory airflow limitation,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 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 - 20050418	VARD – 20050316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fixed Expiratory Airflow Limitation	6602	10%	Fixed Expiratory Airflow Limitation
Gastroesophageal Reflux Disease	6699-6602	**	20050420	
Gastroesophageal Reflux	Cat III					
Sliding Hiatal Hernia		No VA Entry	
Anxiety Disorder			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	
** VARD 20050316 award service connection of 20% or more total for Vocational Rehabilitation purposes – No individual rating 

ANALYSIS SUMMARY:  

Fixed Expiratory Airflow Limitation.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in October 2004 for recurrent exertional dyspnea (shortness of breath).  At a 15 October 2004 primary care visit, 9 months prior to separation, the CI reported having daily symptoms and was using an inhaled bronchodilator (Albuterol).  The physical examination showed no evidence of asthma.  The examiner prescribed inhaled and systemic anti-inflammatory medications (azmacort and prednisone).  At a follow-up primary care visit 3 days later, the CI reported no asthma problems since the last visit, and the anti-inflammatory medications were continued.  Pulmonary function testing (PFTs, spirometry) in October 2004, showed fixed expiratory airflow limitation, with a forced expiratory volume (FEV-1) of 91% predicted and an FEV-1/FVC of 70%.  Endoscopic bronchoscopy and radiographic studies (X-rays and CT) in November 2004 showed no evidence of any obstructive airway or pulmonary diseases.  

At the 14 January 2005 MEB NARSUM examination, 6 months prior to separation, the CI reported taking no medications, as none of them improved the symptoms.  The physical examination showed “mild to moderate expiratory airflow limitation on forced expiration with end expiratory wheezing that did not resolve with bronchodilators.”  The diagnosis was “fixed expiratory airflow limitation…unresponsive to therapy and limiting activity tolerance.”  PFTs in April 2005, 3 months prior to separation, showed a persistent fixed expiratory airflow limitation.  There was no evidence in the STR that the exacerbations were frequent enough to require monthly visits to a physician.  

At a 20 April 2005 Internal medicine VA Compensation and Pension (C&P) examination for evaluation, 2 months prior to separation, the CI reported use of inhaled bronchodilators (albuterol) as needed, and inhaled anti-inflammatories [azmacort (inhalational steroid)] once daily.  The examiner noted that there was no diagnosis of asthma or chronic obstructive pulmonary disease.  The physical examination showed no evidence of asthma.  PFT’s showed an FEV-1 of 116% of predicted, an FVC of 144%, and an FEV-1/FVC of 79% with an interpretation of “borderline obstructive airway disease.”  Radiographic (X-ray) studies of the chest were normal.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the condition, coded 6602 (asthma), citing normal radiographic and endoscopic findings.  A 16 March 2005 VA rating decision established entitlement to vocational rehabilitation citing that “a 20% (or more) rating [had] been assigned for the following: fixed expiration airflow limitation, gastroesophageal reflux disease.”  

Two separate PFT evaluations (October 2004 and April 2005) documented a fixed expiratory flow rate, corroborated and documented by physical examination in the January 2005 NARSUM.  There was STR documentation of attempted treatment of the fixed airway obstruction with asthma medications, with lack of efficacy, and physician opinion that there was no convincing examination findings of asthma.  As the PEB choose to rate under the 6602 code, panel members deliberated if the asthma diagnosis and code (6602) best described the disability present.  As there was documented wheezing (in the NARSUM), the panel concluded that an analogous code (6520-6602) better described the clinical features present in the STR.  

Under the 6602 code, a 30% rating stipulates evidence of inhalational anti-inflammatory medication therapy.  Prior to separation, there were varying reports of medication usage with lack of efficacy, however, anti-inflammatory medications were prescribed, and the CI did report use of inhaled anti-inflammatories 2 months prior to separation.  This would support a 30% rating under code 6602.  The panel discussed the STR documentation of improved PFTs 2 months proximate to separation, which would not support a rating higher than the 10% adjudicated by the PEB.  Panel members agreed that, although PFTs prior to separation documented an improved FEV1/FVC measurement, IAW VASRD §4.96 Special provisions note (7), this evaluation cannot be used for rating as both the FEV1 and FVC measurements were greater than 100%.  The panel majority 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. 

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 fixed expiratory airflow limitation condition, analogously coded 6520-6602.  
Contended PEB Conditions:  Sliding Hiatal Hernia, Anxiety Disorder, and Gastroesophageal Reflux.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the fixed expiratory airflow limitation condition and IAW VASRD §4.100, the panel majority recommends a disability rating of 30%, coded 6520-6602.  In the matter of the contended sliding hiatal hernia, anxiety disorder, and gastroesophageal reflux conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were 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	
Fixed Expiratory Airflow Obstruction	6520-6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 23 May 17 XXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 26 May 17 XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 15 Jun 17 XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 08 Jun 17 XXXXXXXXXXXXXXXXXX
      (f) PDBR ltr dtd 16 May 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.  The official records of the following individuals are to be corrected to reflect the stated disposition below:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.   
     
3.  Please ensure all necessary actions are taken to implement these decisions including notification to the former members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Acting,