RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00431
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Health Care Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.  

CI CONTENTION:  “As I understood at the time I would be medically retired.  I received a letter separating me 12 Feb 09 which is enclosed.”  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 - 20090204	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 2001.  He was treated with albuterol (inhalational bronchodilator), Atrovent (inhalational bronchodilator), and Advair (inhalational anti-inflammatory/bronchodilator combination), and was able to manage his asthma until placed on the TDRL effective 22 February 2007.  

The 9 October 2008 TDRL NARSUM examination, 4 months prior to TDRL removal, noted that the CI remained dependent on inhaled steroid medication for stabilization of asthma symptoms and required his rescue inhaler approximately three times weekly for acute wheezing episodes.  He had one Emergency Department (ER) visit for asthma since placement on the TDRL, with no hospitalizations.  The CI was using Advair and Proventil inhalers.  The examiner indicated that the CI “requires inhaled steroids and recurrent use of beta-agonists.”  On 10 December 2008 (2 months prior to TDRL removal), pulmonary function testing (PFT) at Saint John Hospital showed an FEV-1 of 94% of predicted and an FEV-1/FVC of 103%.  Medications listed Advair 550 and Albuterol inhaler.  Review of the STR found evidence documenting the CI was prescribed and using Advair and episodic Proventil for asthma, and one ER visit for asthma, during the TDRL period.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The TDRL Removal PEB rated the asthma condition 10%, coded 6602, citing “medication profile supports intermittent use of medication,” normal PFTs, and “rated 10% for intermittent use of 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.”  Panel members considered that the TDRL NARSUM examination reported a current prescription and use of inhaled anti-inflammatory medication.  The military medication profile was considered as one item of evidence for medication use frequency, and was weighed as less probative in value given the CI’s statement of use, Advair issue in December 2008, TDRL NARSUM, civilian PFT evaluation indication of Advair use, likely medication issue during the TDRL ER visit, and other potential non-outpatient MTF pharmacy sources of medication.  Additionally, the 30% rating criteria for asthma for “inhalational anti-inflammatory medication” does not require daily use.  

Panel 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.  There was no PFT evidence to support the next higher 60% 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 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 20160707, w/atchs
Exhibit B.  Service Treatment Record

AR20180001939, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 

Sincerely,					      
Enclosure