RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02089
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Preventive Medicine Specialist, medically separated for “exercised induced bronchospasm” with a disability rating of 10%.

CI CONTENTION:   The CI contends his diagnosis and rating was inaccurate, and that he also suffered from flat feet, shin splints and plantar fasciitis.  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 - 20031105	VARD - 20040414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercised Induced Bronchospasm	6699-6602	10%	Asthma	6602	10%	20030812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Exercise Induced Bronchospasm (EIB).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s EIB condition began in 1994.  The CI was treated with bronchodilator (BD) and anti-inflammatory inhalers and did well for several years.  In April 2002, the CI complained of worsening shortness of breath and decreased exercise intolerance.  He was noted to be hyperreactive to the local environment.  An inhaled BD (albuterol) was used on an “as needed” basis and an inhaled anti-inflammatory inhaler (Flovent) was prescribed in January 2003.  A pulmonary evaluation on 4 April 2003 noted that a methacholine challenge test in March 2003 was a negative study.  The CI was tested with an exercise challenge and demonstrated exercise-induced bronchial hyper-reactivity with a significant allergic rhinitis (AR) component.  The pulmonologist recommended that Advair (combination anti-inflammatory and BD inhaler medication) be re-started and used as needed to control nocturnal symptoms.  The examiner also recommended an allergy consult for AR.  An allergy assessment dated 8 May 2003 noted diagnoses of “asthma, moderate, persistent” and AR.   

During the 27 May 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported taking Flovent and albuterol inhalers for asthma and allergy medications (in addition to other medications).  The 16 July 2003 MEB NARSUM examination, 6 months prior to separation, noted that the CI was using an anti-inflammatory inhaler twice daily, a bronchodilator inhaler twice daily and medications for allergic rhinitis.  Physical examination of the heart and lungs was normal.  The examiner noted the CI had not had any Emergency Room visits nor had he been on any required steroid tapers. Review of the service treatment record (STR) showed no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

At the 12 August 2003 VA Compensation and Pension (C&P) evaluation, 6 months before separation, the CI reported shortness of breath at rest and with walking.  Regarding medications, the examiner noted the CI “has had treatment for his respiratory condition with inhalation of anti-inflammatory medication, steroid therapy and inhalation of medicine to open his windpipe.”  The CI reported asthma attacks yearly, with two to three visits to a doctor for his asthma per year.  He reported lost time from work due to the asthma condition.  Physical examination of the heart and lungs was normal.  The CI denied any episodes of respiratory failure.  Pulmonary function testing (PFTs) performed 2 days later (14 August 2003) showed a normal PFT before medication but with a significant response to bronchodilator medication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the EIB 10%, coded 6699-6602 (analogous to asthma), citing intermittent BD therapy.  The VA rated the asthma condition 10%, coded 6602, citing the VASRD 10% rating language.  A 30% rating under 6602 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.”  Panel members considered that the MEB NARSUM examination reported daily use of a BD inhaler and an anti-inflammatory inhaler.  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.  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 recommends a disability rating of 30% for the EIB, coded 6602.  

BOARD FINDINGS:  In the matter of the exercised induced bronchospasm 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	
Exercise Induced Bronchospasm	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010111, 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