RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02347
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transportation Operator, medically separated from the Temporary Disability Retired List (TDRL) for “Retinal Detachment [Left Eye]” and “Asthma,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  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- 20060906	VARD - 20060403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Retinal Detachment [Left Eye]	6008-6080	10%	Decrease Visual Acuity…Left Eye	6079	10%	20051114	
Asthma	6602	0%	Asthma	6602	30%	20051114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Retinal Detachment (Left Eye).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced a spontaneous left eye retinal detachment in September 2003.  He underwent repair surgery but subsequently developed significant visual acuity problems.

At the 14 November 2005 VA Compensation and Pension (C&P) evaluation, 11 months before separation (TDRL removal), the CI reported he had difficulty with his vision.  He used contact lens but they became cloudy and he was unable to obtain replacements.  Physical examination showed his left eye with best correctable visual acuity of 20/60, and 20/200 uncorrected.  All other aspects of the eye examination were unremarkable except for macular scar as a residual from retinal detachment.

During the 10 March 2006 TDRL Re-evaluation, 7 months prior to separation (TDRL removal), the CI reported he could not see with the left eye.  Physical examination showed right eye vision of 20/15 -1 and left eye of 20/150.  There was a cyst over the scleral band.  The lens in both eyes were clear.  The left eye showed retinal pigment and epithelia clumping due to long standing retinal detachment.  The left eye had a large area of chorioretinal scar on the temporal side.  The examiner opined, status post repair of long standing retinal detachment resulted in:  an anatomically well-repaired and stable left eye; macular denegation, and a conjunctival cyst over the scleral band left eye was stable.

The 27 July 2006 TDRL Re-evaluation, 2 months prior to separation (TDRL removal), noted complaints of blurry vision in the left eye with occasional pain and flashes.  Double vision was not reported.  Physical examination showed right eye vision of 20/15 and left eye of 20/70.  The lens in both eyes were clear.  Evidence of muscle or nerve impairment was absent.  Left eye showed macular changes.  The examiner noted the repair of the retinal detachment was stable and there was reduced temporal and central vision, as well as a conjunctival fluid cyst in the left eye that was stable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left eye condition 10%, analogously coded 6008-6080 (detached of retina-visual field defects), citing the findings at the second TDRL re-examination.  The VA also rated the left eye condition 10%, coded 6079, based on the C&P examination 11 months before separation (TDRL removal), citing 20/60 corrected visual acuity.

Ratings for impairment of field vision reflects a 10% disability when there is loss of nasal half of visual field, or when vision in the affected eye is 20/70.  The TDRL re-evaluation examination recorded left eye visual acuity of 20/70, justifying the 10% rating but no higher for the left eye condition.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left eye condition.

Asthma.  According to STR and the MEB NARSUM, the CI’s asthma condition began in June/July 2003 after running in formation.  After several episodes of shortness of breath (SOB), he was prescribed an inhaler.  Overtime, he noted shortness of breath even without exercise.  The CI underwent pulmonary function tests (PFT) and was diagnosed with asthma.  He was treated with Advair and Albuterol inhalers, but continued to experience SOB with wheezing when he attempted to run.  Due to the persistent nature of his condition, the CI was referred to the MEB.

At the 14 November 2005 VA Compensation and Pension (C&P) evaluation, 11 months before separation (TDRL removal), the CI reported SOB in hot temperatures and when climbing stairs.  He was being treated with Advair, Flonase, and Claritin and noted that his medications helped.  He had no episodes of incapacitation.  Physical examination was unremarkable.  PFTs performed on that day recorded FEV1/FVC of 86%, FVC of 85%, and FEV1 of 88%.

The 11 April 2006 TDRL Re-evaluation, 6 months prior to separation (TDRL removal), noted complaints of SOB and wheezing during exertion.  The examiner noted no active mediations were found in the military pharmaceutical tracking system.  However, the panel agreed the examiner did not inquire or address the CI’s asthma medication; as the CI utilized a civilian doctor to treat the asthma condition.  Physical examination was unremarkable.  The examiner noted that recent PFT showed FEV1 at 83% predicted and FVC of 79%.  The examiner opined that the CI’s condition was unchanged since TDRL placement and that he was still unable to perform on active duty.  The CI could do “little if any exertional activity” and had gained 30 pounds over the past year.  The panel noted the CI’s used Advair prior to TDRL placement and while on TDRL.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 0%, coded 6602 (asthma, bronchial), citing no current use of asthma medication.  The VA rated the asthma condition 30%, also coded 6602, based on the C&P examination 11 months before separation (TDRL removal), citing inhalational anti-inflammatory medication (Advair).

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 panel agreed that CI’s TDRL-PFT values were not compensable.  The panel deliberated extensively over the CI’s TDRL asthma medication use.  Based on the MEB NARSUM addendum, VA examination and TDRL Re-evaluation, the panel 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 at separation (TDRL removal).  The TDRL Re-evaluation examiner did not inquire or address the CI’s asthma medication; however, the examiner opined that the CI’s condition was unchanged since TDRL placement and that the CI was still unable to perform on active duty.  Further stating, the CI could do “little if any exertional activity” and had gained 30 pounds over the past year.  The panel noted the MEB NARSUM addendum documented the CI’s use of Advair at TDRL placement (SOB when trying to run/exertion) and the C&P examination documented the CI utilized Advair while on TDRL.  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 retinal detachment condition and IAW VASRD §4.84a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  There were 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	
Retinal Detachment [Left Eye]	6008-6080	10%	
Asthma	6602	30%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150718, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 

AR20170012494, 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 40% 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