RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00619
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20060531

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

CI CONTENTION:  The VA rated the asthma condition 30% and PTSD 70%.  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 -20060124	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma 	6699-6602	10%	Asthma	6602	30%	20080512	
Latent Tuberculosis	Cat II	No VA Placement	
Alcohol Induced Mood Disorder	Cat IV	PTSD	9411	50%	20080512	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a positive tuberculin skin test in December 2003, but a negative workup for active tuberculosis (including a negative chest X-rays), and was treated with a 9-month course of isoniazid (antibiotic).  In February 2004, he was diagnosed with asthma and placed on Advair (steroid/inhalational bronchodilator) and albuterol (inhalational bronchodilator).  Despite medication treatment, he continued to have dyspnea with exertion, as well as at rest, approximately 7 to 10 times a week.  Computerized tomography (CT) imaging of the chest on 25 February 2004 demonstrated a 7-mm lymph node in the aortopulmonic (AP) window of the mediastinum.  A chest X-ray on 11 February 2005 showed no acute disease.  At a pulmonary clinic visit on 10 March 2005, expiratory wheezing was heard.  A 14 March 2005 CT scan demonstrated 7 x 5 x 5 mm, non-enlarged, but “shotty” lymph nodes seen at the level of the AP window.  At a pulmonary clinic visit on 4 October 2005, the CI complained of wheezing and shortness of breath after being lost to follow-up; his medications for asthma (Advair and albuterol) were renewed.  

At the 17 October 2005 MEB NARSUM examination, 7 months prior to separation, the examiner noted bilateral expiratory wheezes.  Pulmonary function studies in April 2004 showed mild expiratory obstruction and repeat testing revealed an FVC of 77% and FEV1/FVC of 83%.  Improvement was noted with bronchodilators.  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 rated the asthma condition 10%, analogously coded 6699-6602 (asthma).  The PEB listed latent tuberculosis infection as a Category II condition (contributes to the unfitting condition); however, the latent tuberculosis was independent of the asthma, having been noted as part of an evaluation, and did not contribute to the disability of asthma in this case.  Therefore, the panel concluded the Category II diagnosis was not a condition which could be reasonably justified as separately unfitting.  Members agreed the latent tuberculosis infection more likely than not should be classified as a Navy Category III condition (not separately unfitting and does not contribute to the unfitting condition).  

Panel members noted that the current prescriptions and use of daily inhaled anti-inflammatory medication documented at the pulmonary clinic visit and in the NARSUM, and 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 6699-6602.  

Contended PEB Condition: Mood Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not noted on an abbreviated limited duty report or implicated in the non-medical assessment.  On 21 October 2005, the CI’s commanding officer stated the CI was “an excellent Marine.”  The 6 December 2005 NARSUM addendum mental status examination (MSE) revealed the CI’s mood was subdued and affect was slightly blunted, but within normal limits.  He was oriented to person, place, time and situation.  His narrative was logical, coherent, linear and he had a future orientation.  There was no evidence of loose associations or circumstantiality.  His speech was spontaneous and normal in rate, rhythm and volume.  Cognition was grossly intact.  Intelligence was average and abstraction was adequate.  Recent and remote memory appeared intact.  There was no gross evidence of organicity or psychomotor symptoms.  He reported some suicidal ideation and some mild intent, but without plans.  There was no homicidal ideation, psychotic symptoms, auditory or visual hallucination, paranoia, ideas of reference or an active delusional system.  Judgment was intact; insight was fair to good; and impulse control was grossly intact.  On 26 December 2005, the CI was admitted to the hospital after his blood alcohol was found to be elevated.  An initial MSE revealed him to be alert and oriented in four spheres.  Mood was described as “tired.”  Affect was appropriate to mood with full range.  During the hospital course it was determined his recent depressive symptoms were more consistent with an adjustment disorder with mixed behavior or ideation mood disturbance secondary to financial stressors and occupational stressors related to his pending medical discharge.  He admitted alcohol had been a major factor in many altercations and he wanted to quit drinking and was amenable to a substance abuse rehabilitation referral.  He denied any suicidal or homicidal ideation, plan or intent and did not display or endorse any such behavior or ideation during the hospital stay.  The MSE on discharge revealed the CI’s mood to be euthymic and his range and intensity of affect was neither increased nor decreased and was appropriate to the topics of discussion.  He denied suicidal or homicidal ideation, plan or intent.  His judgment and insight were fair and impulse control was intact.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6699-6602 IAW VASRD §4.97.  In the matter of the contended mood disorder, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma 	6699-6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160805, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		     COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	 (b) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (g) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX    
	 (h) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (i) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.
    
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                              	XXXXXXXXXXXXXXXXXX
                              	Acting