RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01667
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Network Switchboard Operator, medically separated for “exercise induced shortness of breath…analogous to bronchial asthma,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 – 20081204	VARD - 20090609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Shortness of Breath	6699-6602	10%	Exercise Induced Asthma…	6602	NSC	20090328	
Depression	Not Unfitting	Depression	9434	NSC	20090312	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Exercise Induced Shortness of Breath Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began while stationed in Korea in 2006 following an upper respiratory infection.  The CI’s pulmonary symptoms progressed to shortness of breath with running and subsequent shortness of breath with brisk walking.  Numbness in his hands and some nausea with occasionally vomiting was reported along with occasional squeezing sensation in his chest and tightness in his throat.  Pain intensity was described as 3-4 out of 10.  Pain was relieved by stopping the activity.  A pulmonary function test in December 2006 determined a borderline response to bronchodilators. In March 2007, the CI had a permanent change of duty station; however, the symptoms continued.  In December 2007, the CI was given a permanent profile.  Cardiology evaluation was not able to determine specific etiology for the CI’s symptoms.  A methacholine challenge performed 29 July 2008 was negative.  In August 2008, ventilation perfusion scan was normal and chest CT studies were unremarkable except for 2 small pulmonary nodules.  Pulmonary Function test on 4 September 2008, showed FEV1 predicted at 93% and FEV1/FVC ratio at 77%.  Nuclear Medicine stress test in October 2008, showed ventricular function to be normal.  Echocardiogram study was reported as normal.  Despite treatment, the shortness of breath on exertion condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “shortness of breath” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated November 2008, 4 months prior to separation, the CI reported an inability to exert or exercise due to shortness of breath.  Physical examination showed normal cardiac and pulmonary evaluations.  The MEB NARSUM examination on 6 November 2008, 4 months prior to separation, noted complaints of shortness of breath when wearing the chemical equipment and vigorous exercise.  No asthma related medications were reported.  Physical examination showed lungs clear and no cardiac murmurs, gallops or rubs.  At the 28 March 2009 VA Compensation and Pension (C&P) evaluation, performed at separation, the CI reported shortness of breath with exertion.  No asthma related medications were reported.  Physical examination showed lungs clear, no cardiac murmur, rubs, or gallops.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6699-6602 (analogous to asthma), citing intermittent inhaled bronchodilator therapy.  The VA found the asthma condition “Not Service Connected” coded 6602 (asthma), based on the VA C&P examination at separation, citing no evidence of a diagnostic or specialist criteria for asthma or cardiopulmonary limitations.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Board members noted the MEB NARSUM and VA C&P examinations both reported no oral bronchodilators or inhalation medications were used at the time of the examinations.  The medication profile did showed a prescription for Flovent (inhalation steroid) available for use.  A 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  PFT evidence did not support the next higher 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

Contended Conditions:  Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  Psychiatric evaluation on 1 August 2008, found the CI did not have a persistence of any psychological symptoms that interfered with effective military performance.  After due deliberation, the Board concluded 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended depression conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006655, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure