RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02002
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050228

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

CI CONTENTION:  The CI contends he was “only given 10%” for his lungs.  He also contends for conditions not identified by either the MEB or PEB.  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 - 20050119	VARD - 20050822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma…	6602	10%	Bronchial Asthma	6602	10%	20050510	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 2003 prior to deployment to Iraq.  The CI was prescribed Flovent and albuterol metered dose inhalers and deployed.  The CI did not require any oral steroids or antibiotics.  Upon redeployment in April 2004 breathing tests were ordered and the CI was diagnosed with asthma in August 2004.  Despite treatment, the asthma 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 “moderate persistent asthma” for PEB adjudication.  On 2 August 2004, the CI had a Methacholine Challenge test (MCC), which showed his Force Expiratory Volume in one second (FEV1) was 100% of predicted and FEV1/Forced Vital Capacity (FVC) was 103%.  On 19 October 2004, the CI had a MCC, which showed his FEV1 was 95% of predicted and FEV1 FVC was 100%.  The examiner annotated that the CI possibly suffered from early obstructive pulmonary impairment due to the significant increase in the Force Expiratory Flow (FEF) 25 – 75% after the administration of a bronchodilator.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 November 2004, 3 months prior to separation, the CI reported taking Advair 250/50 1 puff a day, albuterol MDI two puffs at least twice a day, Claritin 10 mg tablets one tablet a day, Flonase one spray to each nostril once a day.  The CI also reported an increase in “nocturnal asthma attacks.”  The examiner noted the CI had a positive Methacholine Challenge test in August 2004.  The MEB NARSUM examination on 3 January 2005, 1 month prior to separation, noted that the CI was taking Advair 250/50 1 puff a day, albuterol MDI two puffs at least twice a day, Claritin 10 mg tablets one tablet a day, Flonase one spray to each nostril once a day. The examiner noted that the medications improved the CI’s symptoms, but still met criteria for moderate persistent asthma. The CI did not require any oral steroids or antibiotics and was also advised to lose weight and quit smoking.  The examiner also noted the CI usually experienced nocturnal symptoms 1-2 times per month and that he used his albuterol inhaler before physical training and once in the evening. The examiner recorded the CI became short of breath after running 1 mile and was unable to pass the run portion of an APFT and that he had not passed it since 2002. Review of the STR showed at least monthly visits to a physician for required care of exacerbations during the 7 months leading up to the time of separation.  A chest X-ray in July 2004 was normal.  At the 10 May 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the examiner noted that the CI was taking albuterol inhaler and Advair inhaler, as needed with good relief.  PFT’s showed an FEV-1 of 95% of predicted and an FEV-1/FVC of 85%.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the moderate persistent asthma 10%, coded 6602 (bronchial asthma), citing FEV1 of 95% after treatment, not requiring inhalational treatment.  The VA also rated the asthma condition 10% coded 6602 (bronchial asthma), based on the VA C&P examination 2 months after separation, citing an evaluation of 10% is granted whenever there is forced expiratory volume in one second (FEV-1) of 71 to 80% of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 71 to 80%; or intermittent inhalation or oral bronchodilator therapy.  The CI’s moderate persistent asthma condition met criteria for a 30% rating, but not higher, under diagnostic code 6602, as documented evidence reported daily use of inhalation or oral bronchodilator therapy on the MEB examination, 3 months prior to separation and the MEB NARSUM examination, 1 month prior to separation from military service.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was sufficient cause to recommend a change in the PEB adjudication for the moderate persistent asthma.  

BOARD FINDINGS: In the matter of the moderate persistent asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  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	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004070, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure