RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01747
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20041215

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

CI CONTENTION:  “I feel my rating should be changed because I am considered to be a chronic asthmatic and this has been a constant struggle.  I have a rescue inhaler which I carry around daily.  I also have a nebulizer machine that I have to use when my peak flow readings get low.  Because of me being a chronic asthmatic, I have been forced at times to leave work early and even at one of my previous job even quit.  At times my asthma doesn’t allow me to complete some of my daily tacks because of shortness of breath.  So with this please review my case and make any changes that you see fit.”  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20041026	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	No VA C&P Examination in Evidence	
Allergic Rhinitis	Category II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in May 2003 involved with a field exercise during which he developed mild wheezing symptoms while sleeping outdoors.  Symptoms progressed to severe dyspnea and shortness of breath.  The CI was prescribed Flovent (inhalational anti-inflammatory medication) two puffs twice daily, and Albuterol (inhalational bronchodilator therapy) as needed.  

On 21 August 2003 (16 months prior to separation), pulmonary function testing (PFTs) showed an FEV-1 of 80% of predicted and an FEV-1/FVC of 81%.  According to the 14 November 2003 internal medicine clinic evaluation, 13 months prior to separation, the examiner noted that the CI had childhood asthma that resolved around age 12.  The examiner also noted that the CI was on Singular, Albuterol, Flovent, Allegra, and a nebulizer, with no indication of frequency of use.  At the time of the 19 November 2003 dental appointment, 13 months prior to separation, the CI indicated that he had an asthma attack at the age of 12, and that he was not presently on medication.  At the time of a dental appointment on 27 February 2004, the CI indicated that he was not taking any medications.  

There was no evidence of further treatment or frequency of medication use until a pulmonary disease clinic appointment on 17 June 2004, 6 months prior to separation.  The examiner listed Advair (inhalational anti-inflammatory medication), Proventil (inhalational bronchodilator), and Singulair (oral indirect-acting bronchodilator) under the clinical note section with no indication of frequency of use.   

During the 1 September 2004 MEB examination (recorded on DD Form 2807-1), 4 months prior to separation, the CI reported taking Singular, Flonase, Allegra, and using an Albuterol nebulizer, with no indication of frequency of use.  The CI also reported allergies to grass, pollen, and seafood.  The examiner reported that the CI was currently on a stable medication regimen for treatment, but did not list the medication or frequency of use, and that the CI still developed moderate wheezing and dyspnea with aerobic activity, especially in humid weather.  

The 13 September 2004 MEB NARSUM examination, 3 months prior to separation, noted prescriptions of Advair once a day; Albuterol by nebulizer once a day to twice a day and by inhaler as needed; and Singulair (oral indirect-acting bronchodilator) once per day.  The CI reported that his wheezing became chronic with exacerbations linked to the springtime season and wet weather conditions.  The examiner reported that a pulmonologist in June 2004 diagnosed the CI with severe persistent asthma and allergic rhinitis.  Physical examination showed faint inspiratory and expiratory wheezing, diffuse, and bilateral that cleared with cough and the lungs were otherwise normal.  The diagnosis was “asthma, severe persistent.”  There was no VA Compensation & Pension examination in evidence.

The CI indicated in his appeal to the PEB (FAX dated 22 October 2004) that his condition warranted a 30% rating “because of the daily medication that I am taking.”  He attached a medication profile, which showed that on 28 August 2003, 16 months prior to separation, he was prescribed Albuterol (as needed) and Singulair (once a day).  At the time of a dental appointment on 9 December 2004, the CI indicated that he was presently using an Albuterol inhaler, with no indication of frequency.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), with the worksheet (JDETS) citing PFTs “indicated good response to treatment” (inhalers), with likely application of SECNAVINST 1850.4E.  The Navy PEB also listed allergic rhinitis as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable), which will be discussed following the asthma condition.  

With regard to rating the asthma condition, panel members considered that the STR and MEB NARSUM reported current prescription and use of daily oral (Singulair) and/or inhaled bronchodilators (albuterol), with documentation of at least intermittent use of Flovent or Advair (inhaled anti-inflammatories), and that the MEB NARSUM examiner prescribed use of Advair proximate to separation.  For rating under code 6602 (asthma), the 30% criteria does not require daily use of inhaled anti-inflammatories, and the rating criteria is met with use of inhaled anti-inflammatories at least intermittently.  

The panel weighed the evidence of medication use from the Report of Medical History (DD Form 2807-1), NARSUM, appeal memorandum, dental examination questionnaires, and STR entries.  No entries specified use of oral or inhaled bronchodilators as less frequently than daily; although when frequency of use was not specified, speculation could be made that albuterol inhaler prescribed on an “as needed” basis was not used on a consistent day-to-day basis.  

The panel majority agreed that the preponderance of the record supported 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, or daily oral or inhaled bronchodilators.  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 majority recommends a disability rating of 30% for the asthma condition, coded 6602.  

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 above 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.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the Category II allergic rhinitis condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The single voter for dissent submitted the appended minority opinion.  The panel majority 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 20150629, w/attachments
Exhibit B.  Service Treatment Record

Minority Opinion:  The panel minority notes that the timeline for the CI’s use of asthma medications was full of inconsistencies.  In August 2003, the medication profile showed that the CI was prescribed an Albuterol inhaler as needed and Singulair once daily.  On 19 November 2003 the CI indicated that he was not using any medications.  On 27 February 2004 he indicated that he was not taking any medications.  On 17 June 2004 a clinic note listed Advair, Proventil and Singulair, but there was no indication of whether this was a medication use history, a current listing of prescriptions, or a medication therapy plan.  The CI indicated on the 1 September 2004 medical history form, 4 months prior to separation, that he was currently using Singular, an Albuterol inhaler and an Albuterol nebulizer.  However, on 9 December 2004, 6 days prior to separation, the CI indicated that he was only using an Albuterol inhaler (frequency of use was not stated).  This last statement is consistent with the CI’s current use of asthma medication as noted in his contention:  “I have a rescue inhaler which I carry around daily.  I also have a nebulizer machine that I have to use when my peak flow readings get low.”  The evidence showed that he did use Singulair, but not on a consistent basis, probably only when he had exacerbations linked to the springtime season and wet weather conditions, as stated above.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel minority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  The panel minority, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

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 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(c) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX
  
	(d) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(e) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(f) PDBR ltr dtd 07 Jul 17 XXXXXXXXXXXXXXXXXX

	(g) PDBR ltr dtd 02 Aug 17 XXXXXXXXXXXXXXXXXX

	(h) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (h) 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: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.      

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

     d. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

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

     f. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.       
     
3.  Please take action to implement these decisions.

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