RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00415
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “asthma” with a disability rating of 10%.   

CI CONTENTION:  “I was, and am still on daily medications to control my “Asthma”…the VA immediately upon separation rendered a 30% rating for this illness.  This should have retired me in 2005…”  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 - 20050816	VARD - 20051222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20050831	
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 first developed intermittent respiratory symptoms in July 2003 while deployed to Iraq.  Recurrent shortness of breath and wheezing with exercise led to evaluation for possible asthma.  Although initial pulmonary function testing (PFT) in November 2004 was normal, provocation testing (methacholine challenge) confirmed the presence of reversible airway obstruction consistent with the diagnosis of asthma.  The CI was started on therapy with Advair and Singulair.  At the pulmonary specialty care consult on 21 January 2005 (10 months before separation), the examiner noted that the CI continued to have symptoms of cough, wheezing, and shortness of breath with cardiovascular exercise and “had been using his Singulair and albuterol along with Advair without much improvement.”  The 13 June 2005 MEB NARSUM examination, 5 months prior to separation, noted that the CI was taking Singulair tabs and albuterol inhaler but did not note frequency.  The examiner referenced the PFTs taken in November 2004 (1 year prior to separation) which were interpreted as normal, and noted that the diagnosis of asthma was made after methacholine challenge results showed a 20% fall in FEV-1 at a methacholine dose of 2.5mg/ml.  Medication lists contained in the records made available to the panel reflected that Advair was prescribed in December 2004 at the time of the CI’s initial diagnosis, but had not been refilled as of the date of the formal PEB on 16 August 2005.  Singulair, with daily use instructions, had been prescribed on 1 June 2005 and refilled on 8 August 2005.  Albuterol, with instructions to use every 6 hours as needed, had also been prescribed and refilled several times since July 2004.  

At the 31 August 2005 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the examiner reported that the CI was prescribed Singulair and albuterol for his asthma and that the CI “requires inhalation of anti-inflammatory medication and bronchodilator by inhalation daily.”  It was unclear why it was reported that the CI required anti-inflammatory medications but had not been prescribed any.  PFT results taken that day were within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing use of medications.  The VA rated the asthma condition 30%, coded 6602, (asthma), based on the C&P examination 3 months before separation, citing daily use of Singulair.  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.”  Panel members considered that while the NARSUM examiner was silent regarding frequency of use of medications, the VA C&P examination reported daily use of inhalational bronchodilators.  The medication record also supported current prescription and daily use of Singulair, an oral bronchodilator, during the period prior to separation.  Members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or 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 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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015561, 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