RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00571
BRANCH OF SERVICE:  army	SEPARATION DATE:  20040629

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

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  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 - 20040402	VARD - 20041221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, with Normal Spirometry	6602	10%	Asthma	6602	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma, with Normal Spirometry.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in late 2001 when she started experiencing intermittent respiratory symptoms.  She had an exacerbation in November 2002 during training that required her to wear a gas mask, and a formal diagnosis of asthma was established by a pulmonologist in February 2003.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  

During the MEB examination (recorded on DD Forms 2807-1 and 2808) signed 19 June 2003, 12 months prior to separation, the CI reported taking Advair (inhaled anti-inflammatory), albuterol (inhalational bronchodilator), and Singulair (oral indirect-acting bronchodilator), without specifying frequency of use.  The MEB NARSUM examination on 15 August 2003, 10 months prior to separation, noted that the CI reported she was taking her albuterol eight puffs per day and consult indicated use of Advair and albuterol.  The examiner noted she was unable to perform required duties including training in protective gear and running.  History indicated three emergency department visits with one course of systemic steroids, without hospitalization.  Physical examination of the lungs was normal.  The diagnosis was moderate persistent asthma, and the physician recommended continuation of medications of Advair twice daily, Singulair daily, and albuterol as needed.  The pulmonologist stated that “current clinical condition of this service member is one that requires the use of, daily controller medications.”  

On 7 November 2003 (7 months prior to separation), pulmonary function testing (PFTs) showed an FEV-1 of 103% of predicted and an FEV-1/FVC of 109% and were interpreted as normal.  The medication profile noted three albuterol inhalers (sufficient for 3 months of twice-daily use) dispensed on 31 October 2003 (7 months prior to separation), a prednisone dose pack (systemic steroids) dispensed on 7 August 2003 (11 months prior to separation), 30-day supply of Singulair dispensed on 19 June 2003 (12 months prior to separation), and Advair (30-day supply) dispensed on 30 December 2002 (18 months prior to separation).  Review of the STR found no clinical note aligning with the single episode of dispensed oral steroids in the year prior to separation.  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 (including sworn testimony) rated the asthma condition 10%, coded 6602, indicating that spirometry was normal and the medication profile showed the CI was not taking medications as prescribed.  The PEB disability description stated that their 10% asthma rating was for “intermittent inhalational bronchodilator therapy,” implying possible non-compliance as a rating factor by specifying that the “medication profile does not indicate that Soldier has received Advair since December 2002.  Thirty days supply of Singulair was issued on 19 June 2003” (10 months before the Formal PEB findings).  The VA also rated the asthma condition 10%, coded 6602 (asthma), citing normal pulmonary function tests and lack of evidence of treatment since discharge from service as the CI failed to report for a scheduled VA examination.  

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.”  In its deliberations, the members considered the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97.  The panel considered the military medication profile as one item of evidence for medication use frequency and weighed the probative value with other evidence, including the CI’s statement of medication use, and the Formal PEB indication of intermittent bronchodilator therapy treatment.  Panel members considered that the examinations in evidence reported current prescription, requirement, and use of inhaled anti-inflammatories, and that medication profiles in 2004 did not always account for all sources of medication use such as issuance from emergency departments, clinics, and civilian sources.  

For rating under code 6602 (asthma), the 30% criteria does not require daily use of inhaled anti-inflammatories, and the rating criteria is met with use of inhaled anti-inflammatories at least intermittently.  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.  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, with Normal Spirometry	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016261, 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