RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02415
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090410

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 for “asthma” with a disability rating of 10%.  

CI CONTENTION:  “Please consider 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 - 20081223	VARD - 20091027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20091006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in October 2005 shortly after being assigned to Fort Bragg.  One month after his arrival, the CI had his first asthma attack.  Despite temporary profiles, the CI deployed in August 2006, where his symptoms were managed with medications.  However, during the deployment, the CI reported some breathing problems.  After he returned from his deployment, the CI was treated with multiple medications.  Pulmonary function tests (PFTs) in April 2008 showed a fixed airway obstruction with an equivocal methacholine challenge.  PFTs after bronchodilators showed FEV-1 was 74% predicted and FEV-1/FVC was 70%.  In May 2008 pulmonary medicine specialist evaluation for shortness of breath, dyspnea on exertion, and nighttime cough diagnosed moderate persistent asthma.  Despite treatment, the CI continued to have asthma attacks.  The MEB forwarded “asthma, moderate, persistent” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2008, 8 months prior to separation, the CI reported taking Advair (inhalational anti-inflammatory medication), Singulair (oral indirect-acting bronchodilator), and Albuterol (inhalational bronchodilator medication) for his asthma condition.  The MEB NARSUM examination on 28 October 2008, 6 months prior to separation, the CI complained of shortness of breath at rest, particularly in the norming and during physical training.  The CI reported waking up at night with shortness of breath and coughing.  Medications included Albuterol prior to activity as needed, Singulair daily, Claritin daily, and Advair inhaler twice daily.  Physical examination showed lungs were clear to auscultation bilaterally.  PFTs from 7 August 2008 showed FEV-1 83% of predicted and FEV-1/FVC of 72%.  The examiner noted the CI continued to have asthma symptoms in spite of maximal medical treatment.  

At the 6 October 2009 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation in Portland Oregon, the CI reported intermittent periods of coughing every few days, no dyspnea, no wheezing or sputum production.  Nocturnal symptoms were reported for which the CI relied on his albuterol inhaler 2-3 puffs about every 2 days.  Shortness of breath was reported to be exacerbated by exertion and relieved by rest and albuterol.  At the time of the VA C&P examination, albuterol inhaler was the only medication reported.  No oral prednisone requirements or hospitalization were reported.  Physical examination showed lungs were clear to auscultation with good air movement and no wheezing.  Pulmonary function test were recorded as normal with no bronchodilator response noted.  The diagnosis was mild persistent asthma.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% 4 months prior to separation, coded 6602 (Asthma, Bronchial), citing “pharmacy records supportive of intermittent use of Advair and rescue albuterol,” and rating “for FEV-1/FVC between 71% and 80% predicated, and intermittent inhalational treatment use.”  The VA rated the asthma condition 10% coded 6602, based on the VA C&P examination 6 months after separation, citing normal pulmonary function testing and intermittent inhalational or oral bronchodilator therapy.  

The Board adjudged that the Service examinations had the highest probative value for rating at separation, and that the VA examination indicated post-separation improvement.  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.”  Board members considered that inhaled anti-inflammatories (Advair), which are not specified as a daily requirement under the 30% rating provision, were prescribed and used, on at least an intermittent basis, as noted by the Pulmonary, MEB and NARSUM examiners, as well as the PEB disability description.  The 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  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 20150622, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004620, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXXX.

Sincerely,
Enclosure