RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02468
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Explosive Ordnance Disposal Specialist, medically separated for “chronic mild asthma…,” with a disability rating of 10%.

CI CONTENTION:  The CI contends the PEB did not rate his asthma in accordance with VA standards.  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 - 20070525	VARD - 20091210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mild Asthma	6602	10%	Bronchial Asthma/Sleep Apnea	6847-6602	30%	20091102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Mild Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 1999.  The CI used a rescue inhaler (albuterol) as need for shortness of breath on exertion.  

At the 8 March 2007 pulmonary clinic the examiner noted a 2 year history of progressive wheezing and chest tightness with physical activity, prior to going to bed, and during sleep.  The symptoms responded to albuterol.  The examiner obtained a longstanding history of exercise intolerance and recorded that the CI was previously diagnosed with asthma by his primary care provider and prescribed an inhaled corticosteroid and rescue inhaler.  Pulmonary function testing (PFTs) performed on 8 March 2007 (5 months prior to separation), showed an FEV-1 of 57% of predicted and an FEV-1/FVC of 73%.  Repeat PFT testing on 29 March 2007 (4 months prior to separation), showed an FEV-1 of 53% of predicted and an FEV-1/FVC of 69%.   There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

The MEB NARSUM examination on 29 March 2007, 4 months prior to separation, noted that the CI was prescribed Advair 250/50 (1 puff twice per day) and an Albuterol metered-dose inhaler as needed for rescue.  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 6602 (bronchial asthma), citing “intermittent use of inhaled medication.”  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 VA rated the asthma condition 30%, coded 6602, based on the C&P examination 2 years and 3 months after separation.

Panel members considered that the examinations in evidence reported current prescription but not daily bronchodilator use as reported by the CI on the MEB examination dated 28 February 2007.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed, as noted in the examinations.  The NARSUM, treatment record supported that the CI was prescribed Advair for daily use.  Advair, in addition to being an inhalational bronchodilator (salmeterol), also contains an inhalational anti-inflammatory medication (fluticasone). Panel members agreed the evidence supports a rating of 30% for daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication and FEV-1 of 56- to 70-percent predicted.  The panel noted a methacholine challenge which documented a pre-methacholine administration FEV1 of 53% predicted and a worsening of pulmonary function with methacholine administration.  VASRD § 4.69(4) allows for the use of pre-bronchodilator pulmonary function tests in cases where there is post administration worsening.  A FEV1 of 53 % meets criteria for a 60% rating.  IAW §4.7(Higher of two evaluations)  the disability picture has to more nearly approximate the criteria required for the higher rating; otherwise, the lower rating is to be assigned.  Panel members agreed that the CI’s disability (report of dyspnea with exercise and at night; PFTs one month prior to the methacholine challenge; and prescribed medications) most closely approximated the criteria for a 30% 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 bronchial asthma, 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	
Asthma, bronchial	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151020, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013241, 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 and to the counsel you listed on your application; XXXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure