RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01988
BRANCH OF SERVICE:  Army 	DATE REMOVED FROM TDRL:  20050418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 0%.

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 – 20011102/20050322	VARD - 20020326	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Asthma	6602	30%	0%	Asthma	6602	30%	30%	
Congenitally Defective Bicuspid Aortic Valve	Not Unfitting 	Bicuspid
Aortic Valve	7000	NSC	NSC	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma began in 1996.  The MEB forwarded asthma for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 20 June 2001, 8 months prior to separation, the CI was admitted to San Antonio Military Medical Center (SAMMC) for asthma testing and shortness of breath.  Physical examination findings were not annotated regarding asthma.  The MEB NARSUM examination on 12 September 2001, 6 months prior to separation, noted complaints of cough, wheeze, shortness of breath and a positive Methacholine Challenge test.  Physical examination findings were indicative of diagnosis of Reactive Airway Disease (RAD) responsive to improvement with the use of asthmatic medication, specifically beta agonist.  At the 10 January 2002 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported  symptoms of asthma and shortness of breath which started while he was stationed in Korea.  The CI admitted to the use of an albuterol inhaler 3 times per day as needed, Azmacort 2 puffs 2 times per day and Serevent 2 puffs 2 times per day.  Physical examination showed the CI had clear breath and lung sounds bilaterally with normal respiratory rate and effort.  At the TDRL evaluation examination, the CI admitted to using albuterol 10 times per week before exercise and at work, singular once per day and Azmacort. He also stated he was exposed to dust, so he has to use it 1 to 2 times during his workday.  Physical examination at the TDRL examination found the CI’s lungs to be clear to auscultation, good inspiratory effort, no wheezing and good airflow bilaterally.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 0% at TDRL removal, coded 6602 (Asthma, bronchial), citing the CI “is now only using a rescue inhaler as needed” with “lungs clear to exam.”  The VA rated the asthma 30% coded 6602, based on the VA C&P examination 1 month before separation, citing “need for daily inhalational or oral bronchodilator therapy.”  The NARSUM noted the CI was on Azmacort twice a day, Singulair daily, and albuterol 4 times a day.  The TDRL evaluation dated November 2004 noted Advair and albuterol. Board members agreed evidence supports a 30% rating, but no higher, coded 6602 due to the CI stating he used an inhalation anti-inflammatory medication (Azmacort) and or a daily inhalation therapy (albuterol).  A higher rating of 60% coded 6602 is warranted if there was a FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least 3 per year) courses of systemic (oral or parenteral) corticosteroids.  The CI’s condition did not meet the requirements for a 60% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a TDRL permanent disability ratings of 30% for the asthma condition, coded 6602 VASRD §4.100.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination the congenitally defective bicuspid aortic valve condition was not unfitting.  The aortic valve condition was profiled, but not implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the aortic valve condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the aortic valve condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a permanent disability rating of 30%, coded 6602 IAW VASRD §4.71a.  In the matter of the contended congenitally defective bicuspid aortic valve condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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	RATING	
		PERMANENT	
Asthma	6602	30%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150706, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004069, XXXXXXXXXXXXXXXXXX

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,