RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01598
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040702

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, 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 - 20040503	VARD - 20040930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20031031	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in January 2003 for a recent history of recurrent exertional shortness of breath and exercise intolerance.  Initial pulmonary function testing (PFT) was within normal limits.  A diagnosis of asthma was made based on a positive methacholine challenge test on 23 March 2003.  The CI was initially placed on a series of inhaled steroids, one puff twice per day, which he did not tolerate at the prescribed dosage.  He was eventually stabilized on an oral indirect acting bronchodilator (Singulair) once per day, along with once a day treatment with the inhaled steroid (Pulmicort).  The CI was also prescribed an inhaled bronchodilator (Proventil) as a rescue inhaler (as needed).  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 “asthma” for PEB adjudication.  

According to the 23 September 2003 allergy clinic evaluation (9 months prior to separation) the examiner noted that the CI was on albuterol as needed, Singulair every night and Pulmicort twice a day.  PFTs were forced expiratory volume in one second (FEV-1) of 80% of predicted value; and the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 86%.  The examiner’s impression was that the CI had mild persistent asthma that was stable on his current medication.  During the 24 and 27 September 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported taking Pulmicort and Singulair.  

At the 31 October 2003 VA Compensation and Pension (C&P) evaluation (7 months prior to separation), the CI complained of shortness of breath with exertion and wheezing at night.  The examiner noted that the CI required inhalational anti-inflammatory medication and inhalational bronchodilator therapy intermittently.  PFT’s were FEV-1 of 72% predicted and FEV1/FVC of 95%. 

The 24 February 2004 MEB NARSUM examination, 4 months prior to separation, noted that the CI was taking Pulmicort and Singulair on a daily basis, and anti-allergy medication as needed.  Review of the STR found one episode 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 panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing FEV-1 of 78% and intermittent inhalational bronchodilator therapy.  The PEB specifically noted its review of the CI’s medication profile.  The PEB implicated the CI’s possible non-compliance as a rating factor by specifying that the “medication profile does not document daily therapy.”  The VA rated the asthma condition 10%, coded 6602, citing FEV-1 of 71 to 80% of predicted value; or the FEV1/FVC of 71 to 80%; or intermittent inhalational or oral bronchodilator therapy.  

A 30% rating stipulates “FEV-1 of 56- to 70% predicted, or; FEV-1/FVC of 56 to 70%, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Of note, the 30% rating does not require daily use of inhaled anti-inflammatory therapy.  In its deliberations, the members considered the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97.  The panel considered the military medication profile as one item of evidence for medication use frequency and weighed the probative value with other evidence in treatment notes and the CI’s statement of medication use.  Potential sources of medication (ER, inpatient, troop clinics, providers’ samples, pulmonary testing labs, civilian or VA pharmacies, etc.) were not routinely captured in the medication profile proximate to the CI’s date of separation.  Panel members considered that the examinations in evidence reported current prescription and use of daily bronchodilators and use of 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 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 asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.96.  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 20150624, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009560, 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