RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01636
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060426
DATE PLACED ON TDRL:  20060427	
DATE REMOVED FROM TDRL:  20080108

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

CI CONTENTION:  “I would like to be reconsidered because I do not believe I received a fair shot the first time.  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 – 20060404/20070909	VARD - 20071106	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL Removal			TDRL
Removal	
Asthma	6602	10%	Asthma	6602	0%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in October 2005, 9 weeks into Basic Training while exercising.  She was diagnosed with dyspnea (shortness of breath) and prescribed albuterol, a bronchodilator, as needed.  A methacholine challenge test was done on 26 October 2005 that confirmed the diagnosis of asthma with mildly positive bronchial hyper-responsiveness to methacholine based on pulmonary function testing (PFT), which showed a decline in FEV1 (forced expiratory volume at 1 second) of 25% at level 4.  At a clinic visit on 16 November 2005, 5 months prior to TDRL placement, the CI was reevaluated and Flovent (fluticasone, an inhalational steroid) was prescribed.  Because of coughing and throat irritation from the Flovent, the CI was prescribed Singulair (montelukast, an oral indirect bronchodilator) and an Advair (fluticasone/salmeterol, an inhalational steroid bronchodilator combination) metered-dose inhaler (MDI) on 10 January 2006.    The CI was place on TDRL on 4 April 2006.

The 9 September 2007 TDRL NARSUM (based on the re-evaluation done on 27 April 2007), 17 months after TDRL placement and 4 months before TDRL removal noted complaints of the CI experiencing increased shortness of breath when climbing stairs to her apartment and when walking very short distances.  She had not been to the Emergency Room (ER) for exacerbation of her asthma or visited a physician for her condition.  However, she noted she took mometasone (an inhalational steroid) and Singulair daily, and levalbuterol (a bronchodilator) three times per week.  PFTs post albuterol revealed an FVC (forced vital capacity) of 87% predicted, FEV1 of 78% predicted, and FEF 25% (forced expiratory flow 25%) of 59% predicted.   The examiner noted the CI’s condition was not completely stable and recommended continuation of TDRL status “due to her condition changing in the last year from her original disposition.”

At the 16 October 2007 VA Compensation and Pension (C&P) evaluation, approximately 18 months after TDRL placement and 3 months before TDRL removal, the CI reported shortness of breath on severe exertion and the use of levalbuterol as needed, montelukast daily, and mometasone for asthma.  A chest X-ray series on 16 October 2007 showed no active or acute cardiopulmonary disease.  The examiner referenced PFT findings of 20 June 2007 that revealed a very mild obstructive defect with an insignificant change with albuterol, the findings of which were compatible with the diagnosis of asthma.  

The panel directed attention to its rating recommendation based on the above evidence.  At TDRL removal, the PEB rated the asthma condition 10%, coded 6602, citing an FEV-1 of 78% post-bronchodilator and the “medication profile did not reflect daily use of controller medications”.    The VA rated the asthma condition 0%, coded 6602, citing “a noncompensable evaluation is assigned unless there is a forced expiratory volume in one second (FEV-1) of 71 to 80 percent of predicted value; or a ratio of FEV-1 to forced vital capacity of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy.”  

The panel discussed the CI’s rating at the time of TDRL removal.  While a 10% rating requires “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy,” 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.”  Panel members noted the CI took mometasone, an inhalational steroid (an anti-inflammatory medication) on a regular basis as well as Singulair on a daily basis as noted in the TDRL removal NARSUM examination and the VA examination.  Therefore, 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.  However, 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, and 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 for TDRL removal.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97 for TDRL removal.  There were no other conditions within the Board’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%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008728, 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,