RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00601
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040909

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

CI CONTENTION:  The CI contends his PTSD condition has limited his functional status.  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 -20040806	VARD - 20041213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Intermittent Asthma	6602	10%	Mild Intermittent Asthma	6602	30%	20040826	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Mild Intermittent Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in May 2004 when the CI reported episodic shortness of breath lasting approximately several minutes to ½ hour.  The CI reported a history of exposure to JP-4 (jet fuel) for prolonged periods of time.  The Epworth Sleepiness Scale was recorded at 14/24 indicating excessive daytime sleepiness.  A sleep study was ordered.  On 14 April 2004 chest X-ray studies were normal.  On 3 June 2004, overnight polysomnography showed no evidence of significant obstructive sleep apnea or sleep disorders.  On 27 April 2004 pulmonary function testing (PFT) showed FEV-1 of 61 percent (post-bronchodilator) and FEV1/FVC 65 percent (post-bronchodilator).  The pulmonary specialist interpretation was moderate obstructive ventilatory defect, not improved with bronchodilators.  
The 9 July 2004 MEB NARSUM examination, 2 months prior to separation, noted episodic exertional chest tightness with wheezing.  Symptoms were reported as being exacerbated by wearing a protective mask.  Nocturnal symptoms, waking up gasping for air, as well as heroic snoring and excessive daytime somnolence were present.  Most symptoms persisted throughout the day with hyperventilation syndrome occurring.  Physical examination showed lungs clear to auscultation.  Spirometry showed obstruction with no response to bronchodilator.  It was determined that symptoms were consistent with mild intermittent asthma.  

At the 26 August 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported dyspnea on exertion with running, along with night air hunger and difficulty breathing in the morning.  The CI detailed intermittent wheezing.  An albuterol multidose inhaler was used for dyspnea on exertion (walking greater than ½ mile).  The use of an inhaler was reported each “morning and 2 to 3 times per week as needed.”  Physical examination showed the chest was symmetrical with good expansion on inspiration.  Lungs were clear to auscultation without wheezes, rales, or rhonchi.  

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 FEV-1/FVC 81% with CI utilizing intermittent inhalational bronchodilator therapy.  The VA rated the asthma condition 30%, coded 6602, (asthma, bronchial), based on the C&P examination 1 month before separation, citing FEV-1 of 61 and FEV1/FVC of 65.  

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 27 April 2004 PFTs documented results meeting those PFT criteria and there were no other PFT studies in evidence proximate to separation.  The C&P examination was prior to, and closest to, separation and also reported use of daily bronchodilators to support the 30% rating criteria.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of pulmonary function testing and bronchodilator 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%, coded6602 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 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015818, 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