RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01754
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fighting Vehicle Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “asthma,” with a disability rating of 0%.   

CI CONTENTION:  The CI requests his medical retirement benefits be reinstated.  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 - 20031027	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	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 July 1998 while deployed to Bosnia.  A methacholine challenge test performed 26 July 1999 confirmed the diagnosis of asthma with a 36% decrease in the forced expiratory volume in the first second (FEV1) after administration of methacholine.  The CI was treated with inhaled bronchodilators on an as needed basis as well as daily inhaled corticosteroids.  The MEB forwarded “asthma, moderate, persistent” for PEB adjudicated and the CI was placed on the TDRL in February 2000.  While on the TDRL, a medication profiled showed the CI was prescribed an inhaled bronchodilator (Albuterol) to use as needed and an inhalational anti-inflammatory (Budesonide) to use twice daily and each of those were received from the base pharmacy at least 4 of the 12 months prior to the final NARSUM.  A statement from the CI’s German civilian primary care physician 7 April 2003 attested to the CI having been his patient since April 2001 and that he was, at that time, prescribing an inhalational anti-inflammatory (Pulmicot (Budesnoide)), oral bronchodilator (Theoplylline), and oral corticosteroid (Prednisolone), without the dose or frequency listed.  This was the only mention of the use of systemic corticosteroids in the record.  A pulmonary function test (PFT) on 15 May 2003, showed a post-bronchodilator results of FEV1 85% of predicted for age, gender and height as well as FEV1/ forced vital capacity (FVC) 85% of predicted.  

The 11 June 2003 MEB TDRL removal NARSUM examination, 7 months prior to separation, noted the CI had last experienced a significant asthma attack 11 months earlier.  The CI did not require any emergency room visits or hospitalizations.  The examiner noted the CI was taking an inhaled bronchodilator (Albuterol) as needed and inhalational anti-inflammatory (Budesonide) twice daily.  Physical examination was normal.  

As of the time of the panel, the CI did not file a VA claim.  In the CI’s 8 July 2003 appeal to the PEB, the CI stated that he did not use the military health care system routinely because he had private health insurance and due to scheduling conflicts with his employment and hours that the military clinic was available.  

The panel directed attention to its rating recommendation based on the above evidence.  At TDRL removal, the PEB rated the asthma condition 0%, coded 6602, citing no use of asthma medication and non-compensable PFTs.  Additionally, the PEB stated the CI received a 1 month supply of medication in June 2002, but did not seek additional refills and/or medication until April 2003.  There was no VA Compensation and Pension examination in evidence proximate to separation.

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.”  The CI’s PFT results did not warrant a 30% rating.  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, the German physician’s statement 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.  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Panel members considered that the examinations in evidence reported current prescription and use of daily oral bronchodilators and 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.  There was no evidence of FEV1 of 40-55 percent predicted, monthly visits to a physician or intermittent (at least 3 per year) courses of oral corticosteroids to satisfy 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 §4.100.  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 20150629, w/atchs
Exhibit B.  Service Treatment Record

AR20170008791, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX

	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 XXXXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure