RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02038
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20071121

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

CI CONTENTION:  The CI made no specific contention.  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 -20071011	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bronchial Asthma	6002	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:   NA	

ANALYSIS SUMMARY:  

Bronchial Asthma.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in March 2007 with shortness of breath on exertion and her awakening from sleep four times a week to use inhalers to help overcome coughing and wheezing.  The CI had a history of going into sick call for coughing and was placed on medications for "bronchitis."  When seen by Pulmonary Service in March 2007 she was using an albuterol inhaler two to three times per day and at night.  Because of wheezing, she had to discontinue running exercises.  

Baseline pulmonary function tests were initially normal with an FEV1 (forced expiratory volume at 1 second) of 82% predicted and an FEV1/FVC (forced vital capacity) ratio of 87%.  However, there was a suspicion of asthma, so a methacholine challenge was performed in April 2007.  The test, which was abnormal, showed a 28% drop in the FEV1 two thirds of the way into the test, and the test had to be stopped.  The final stages of the test were omitted and the CI was given a bronchodilator treatment which improved her pulmonary function to within 12% of baseline.  The baseline pulmonary function testing of the methacholine challenge did show a mild obstructive defect at the beginning, and this defect was much more severe when the test was stopped.  After the methacholine challenge proved asthma, the CI was then placed on Advair (fluticasone/salmeterol, an inhalational steroid/bronchodilator combination), Singulair (montelukast, an oral indirect-acting bronchodilator), and an albuterol inhaler. She took these medications conscientiously, but did not seem to benefit as much as hoped; therefore, the dose of Advair was increased and the Singulair and albuterol were continued.  Despite the maximum regimen, the CI continued to have difficulty with exercise. 

The 12 September 2007 MEB NARSUM examination, 2 months prior to separation, noted that the CI was using the albuterol inhaler three to four times a day and still woke up at night to use it.  During the 18 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported bronchitis in A-school, shortness of breath because of asthma, use of an inhaler four to five times a day, and was currently taking albuterol, Singulair, and Advair.  The examiner noted no wheezing or shortness of breath during the examination.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6002 (should have been 6602).  A 30% rating requires an “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.”  Panel members noted the NARSUM reported a current prescription and use of a daily bronchodilator (albuterol) as well as an inhaled anti-inflammatory medication (Advair).  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator and inhalational anti-inflammatory medication use.   Since there was no STR in evidence, respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%) could not be determined.  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 §4.97.  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	
Bronchial Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150720, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(c) PDBR ltr dtd 17 Oct 16 ICO XXXXXXXXXXXXXXXXXX, former USMC 
	(d) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(e) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(f) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(g) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC
	(h) PDBR ltr dtd 15 Jun 17 ICO XXXXXXXXXXXXXXXXXX., former USN
	(i) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USN
	(j) PDBR ltr dtd 5 Sep 17 ICO XXXXXXXXXXXXXXXXXX, former USMC 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 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 USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

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

     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

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

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

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

     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Acting