RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01565
BRANCH OF SERVICE:  marine corps	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Metal Worker, medically separated for “asthma” with a disability rating of 10%.  

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 - 20040402	VARD - 20041221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR
Missed VA Exam	
Seasonal Allergic Rhinitis	Category II	Allergic Rhinitis	6522	NSC		
Community-Acquired Pneumonia	Category III	No VA Placement		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in September 2003 as symptoms of wheezing and cough.  

On 24 March 2004 the pulmonary function testing (PFTs), 5 months before separation, showed essentially normal values after bronchodilators (FEV-1 of 96% of predicted and an FEV-1/FVC of 84%).  On 29 March 2004 the methacholine challenge was positive and the pulmonologist subsequently diagnosed asthma and initiated a PEB.  

During the MEB examination (recorded on DD Forms 2807-1 and 2808) signed 5 May 2004, 1 month prior to separation, the examiner documented the CI was utilizing Advair (inhaled anti-inflammatory), Albuterol (inhalational bronchodilator), and Singulair (oral indirect-acting bronchodilator), without specifying frequency of use.  

At the 24 June 2004 MEB NARSUM examination, 2 months prior to separation, the CI reported shortness of breath, wheezing and cough for 7 months.  The examiner noted the CI was unable to perform military duties, physical training, but was able to train in his military specialty.  The examiner opined that the CI’s condition made a significant impact on the CI’s personal life, interrupting normal sleep patterns and would require on-going asthma follow up.  There was no history of asthma related emergency department visits, hospitalization or courses of systemic steroids.  Physical examination of the lungs was normal.  The diagnosis was moderate persistent asthma, seasonal allergic rhinitis, and community-acquired pneumonia.  The physician documented the CI’s current medications as daily:  Advair, Albuterol and Singulair.  

There was no VA examination proximate to separation for this panel to review.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma); as Category I unfitting condition.  The PEB listed seasonal allergic rhinitis was a related Category II condition which contributed to the primary unfitting condition (asthma), but was not separately ratable.  The VA rated the asthma condition 0%, coded 6602, citing the CI failed to report to his VA examination.  

Panel members considered that the pulmonary clinic, troop medical clinic, and MEB NARSUM examination, all proximate to separation, reported a current prescription and use of daily bronchodilators and inhaled anti-inflammatories.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and inhalational anti-inflammatory medication use.  There was no PFT evidence to support the next higher 60% rating.  Additionally, 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.  

The panel notes that the CI also had the related diagnosis of seasonal allergic rhinitis which was adjudicated as a Category II condition.  With regard to the allergic rhinitis condition, the panel’s first charge for this Navy PEB Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  Members concluded that a preponderance of evidence indicated the Category II allergic rhinitis condition was not justified as separately unfitting; given the absence of nasal polyps, recurrent bacterial infections, or other significant nose or throat symptoms.  Any impact that the allergic rhinitis condition had on the CI’s unfitting asthma condition, was considered under the rating for asthma.  After due deliberation, considering all of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the allergic rhinitis condition as a Category II condition, and therefore no additional rating is recommended.  

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 asthma condition, coded 6602.  

Contended PEB Condition:  Community-Allergic Pneumonia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition did not elicit limited duty, was not implicated in the non-medical assessment (commander’s statement), nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended community-allergic pneumonia condition, the panel unanimously recommends no change from the PEB determination as Category III (not unfitting condition).  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	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/atchs
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 07 Jul 17 XXXXXXXXXXXXXXXXXX
 
	(c) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(d) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(e) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(f) PDBR ltr dtd 03 Aug 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 as follows:

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

     e. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.      
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXX

	Acting