RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01616
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Petroleum Lab Specialist, medically separated for “asthma,” with a disability rating of 10%.

CI CONTENTION:  The CI referred to the 1 May 2015 VA Rating Decision.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20030904	VARD - 20150501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20150403	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in March 2002 for a history of exertional shortness of breath while playing baseball.  Albuterol (inhaled bronchodilator) was prescribed and inhaled combination of long-acting bronchodilator with corticosteroid (Advair) were started in 2002.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation in April 2003.  Despite treatment, including escalating doses of inhaled long acting bronchodilators with corticosteroids, 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 “bronchial asthma” for PEB adjudication.

PFTs performed 25 October 2002, 14 months prior to separation, showed a forced vital capacity (FCV) that was 112% of what would be predicted for the CI’s age and height.  The forced expiratory volume over the first second (FEV1) was 108% of predicted.  The forced expiratory flow after the first 25% of expiration until 75% of expiration (FEF25-75%) was 67% of predicted with an increase of 32% after bronchodilator administration which indicates obstruction of the medium-sized airways and was responsive to the bronchodilator.  At the 11 December 2002 primary care clinic visit the Advair was increased from the lowest to the medium dose then again on 8 January 2003 the Advair was increased to the strongest dose.  On 28 January 2003, 11 months prior to separation, PFTs were again performed with FVC of 110% predicted, FEV1 of 107% predicted, FEF25-75% of 71% and a 25% increase after bronchodilator administration.  At a 16 April 2003 internal medicine clinic appointment, an antihistamine and a nasal steroid were added to the therapy.  On 5 May 2003 (8 months prior to separation), PFTs showed an FEV1 of 114% of predicted, FEV-1/FVC of 104% and FEF25-75% 82% of predicted with a 9% increase after bronchodilator administration.

The MEB NARSUM examination on 10 July 2003, 6 months prior to separation, noted complaints of “attacks” at rest and at night that woke her up.  She also reported difficulty working outside in hot weather.  The examiner referred to intolerance of wearing a protective mask that was required for the CI’s MOS.  Medications listed were Advair and Albuterol, but was silent regarding frequency of medication use.  Physical examination revealed clear lungs with no wheezing heard.  The examiner referenced the 28 January 2003 PFTs from above.  Review of the STR found no 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 records indicated Advair and Albuterol continued to be filled after separation.  

At the 1 May 2015 VA Compensation and Pension (C&P) evaluation, performed over 11 years after separation, the CI reported she took Advair and albuterol and used a home nebulizer to administer albuterol.  The CI denied use of oral or parental corticosteroid medications.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing intermittent inhalational bronchodilator therapy and that the medication profile did not verify daily therapy.  The VA rated the asthma condition 30% coded 6602, based on the VA C&P examination over 11 years after separation, citing daily inhalational therapy.  A 10% rating stipulates “FEV1 of 71- to 80-percent predicted, or; FEV1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.”  A 30% rating stipulates “FEV1 of 56- to 70-percent predicted, or; FEV1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  The PFT results in this case showed an FEV-1 greater than 80 percent predicted and an FEV1/FVC greater than 80 percent, therefore the medication was reviewed.  Board members considered that the examinations in evidence reported current prescription of inhalational anti-inflammatory (corticosteroid) medications.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed, as noted by multiple providers.  Board 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 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.  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	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006375, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					       
Enclosure