RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00622
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Master-At-Arms, medically separated for “moderate persistent asthma,” with a disability rating of 10% and reduced to 0% for non-compliance.  

CI CONTENTION:  Back, COPD (chronic obstructive pulmonary disease) and arthritis.  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 (VA), 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 - 20040423	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Persistent Asthma	6602	10%-10%=0%	No VA Rating - No VA Exam in Evidence	
COMBINED RATING:  0%	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 November 2002 with dyspnea (shortness of breath) exacerbated by running.  Chest X-ray (CXR) was normal.  A spirometry baseline evaluation showed an FEV1 of 70-100% predicted and a bronchodilation response with Albuterol, resulting in a diagnosis of asthma.  During the 14 April 2003 Pulmonology evaluation, the CI complained of chronic dyspnea at rest, standing or walking, and made worse with exertion.  The CI had separate additional symptoms compatible with vocal cord dysfunction.  Pulmonary function tests (PFTs) showed an FEV1 of 64 percent predicted, and FEV-1/FVC of 65 percent.  The diagnosis was obstructive lung disease without reversibility on spirometry.  The CI was started on twice daily Advair (inhalational anti-inflammatory), and albuterol (inhalational bronchodilator) as needed for rescue.  

The 26 September 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of shortness of breath (SOB) and difficulty breathing, especially with exercise.  The CI had persistent exertional dyspnea with frequent nocturnal awakening due to wheezing and dyspnea.  Detailed history was provided including a single course of systemic steroids prescribed in July 2003 following worsening symptoms when the CI had run out of medication for two months and was then restarted on medications.  The CI continued to smoke and had separate symptoms of vocal cord dysfunction and possibly panic attacks leading to additional respiratory symptoms at rest.  

Physical examination showed expiratory wheezing bilaterally.  PFTs documented FEV1 of 64 percent predicted and FEV-1/FVC of 81 percent post-bronchodilator.  There was no significant PFT response to bronchodilation.  The examiner instructed the CI to the following medication regimen:  Advair twice daily; Singulair (oral bronchodilator) at bedtime, and Albuterol daily as needed.  The physician indicated the CI had improved since reinitiating Advair and Singulair, but still had symptoms with minimal activity described as chest tightness, cough and wheeze.  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%, reduced to 0%, for non-compliance, coded 6602 (asthma).    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.”  Of note, inhalational anti-inflammatory medication is not specified as “daily.”  A 30% rating was supported by FEV-1 of 64 percent predicted noted by the NARSUM examination, or the FEV-1/FVC of 70 percent noted on multiple prior PFT examinations.  There was no PFT evidence to support the next higher 60% rating.  Panel members also considered that inhaled anti-inflammatories were prescribed / used, as noted by the pulmonologist and NARSUM examiners.  Panel members agreed the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of PFTs 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 the CI’s prior determination be modified as follows; and, 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 20160913, 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