RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00145
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030801

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

CI CONTENTION:  “Asthma.”  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 - 20030428	VARD - 20040831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20040224	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented in 2000 with several year history of asthma.  He was treated with an anti-inflammatory inhaler (Vanceril [beclomethasone]) and a rescue bronchodilator inhaler (albuterol).  A pulmonary function test performed in June 2002 showed an FEV1 (forced expiratory volume at one second) of 121% predicted normal (PRED) and FEV1/FVC (forced vital capacity) of 113% PRED, with an 8 percent increase in FEV1 after bronchodilator medication (12% or greater consistent with asthma).  At a 24 July 2002 primary care visit, the CI reported his asthma symptoms had recently worsened with seven to eight attacks per day.  The examiner indicated this was moderate, persistent asthma and the CI’s medications were changed to a combination inhaler with anti-inflammatory and long-acting BD medications (Advair) and albuterol as needed was continued.  At a 6 November 2002 clinic visit the CI reported daily use of Advair with daily symptoms with activity requiring use of the albuterol inhaler three times a day.  The CI did not require at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.

During the 15 January 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported asthma and current use of Advair and albuterol.  The 26 March 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of shortness of breath.  Current medications were Advair and albuterol as needed.  A pulmonary function test performed in February 2003 showed FEV1 113% and FEV1/FVC at 106%, with 20% improvement in small airway function after bronchodilator medication.  Physical examination of the heart and lungs was normal.

The 24 February 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, documented asthma treated with Advair twice daily and albuterol as needed.  The VA examiner noted PFTs (no date cited) showed no indication of obstructive ventilation.  Physical examination of the heart and lungs was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing intermittent inhalational bronchodilator therapy with last refill of the anti-inflammatory inhaler in mid-December 2002.  The VA also rated the asthma condition 10%, coded 6602, based on the C&P examination 7 months after separation, also citing intermittent inhalational bronchodilator therapy.

Both the MEB NARSUM and C&P examinations reported daily use of Advair (an inhalational anti-inflammatory medication) for the treatment of asthma.  Notes in the STR showed regular refill of both anti-inflammatory and bronchodilator inhaled medications throughout 2002.  Board members agreed that the VASRD §4.97 threshold for a 30% rating and no higher was reasonably satisfied in this case on the basis of use of inhalational anti-inflammatory medication, which does not specify daily use.  A higher rating was not justified in the absence of sufficiently abnormal PFTs, at least monthly visits to a physician for required care of exacerbations, intermittent (at least three per year) courses of systemic corticosteroids in the past year, or episodes of respiratory failure.  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	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160204, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014073, 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