RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00676
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE: 20040521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma, with normal spirometry, on intermittent bronchodilator therapy” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20040331	VARD - 20040510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, with Normal Spirometry, on Intermittent Bronchodilator Therapy	6602	10%	Asthma	6602	10%	20040415	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was placed on the TDRL in July 2002 with asthma rated at 30%.  At the 24 October 2003 TDRL Evaluation, 7 months prior to TDRL removal, the CI stated she was taking albuterol (inhalational bronchodilator) daily although it was prescribed to take as needed.  A medication profile submitted with the evaluation revealed that albuterol, Flovent (inhaled corticosteroid), and Montelukast (Singulair…oral bronchodilator) were prescribed for the CI and filled on 24 October 2003, the date of the evaluation.  No medication profile was available for the period after placement on the TDRL prior to the re-evaluation.   

At the 24 October 2003 TDRL re-evaluation, the CI endorsed “…has asthma attacks one to two times per week and also has daily symptoms.”  “She [CI] has had no emergency room visits since her MEB was completed in March 2003.  She states she has received no new diagnoses by any civilian physicians.”  Her medications included albuterol (prescribed for “as needed”) which she is using daily, Flonase and Claritin (antihistamine) which she also uses daily.  She admits to symptom exacerbation with running, vigorous exercise, or exposure to grass, molds, and dust.  Her physical examination was listed as “unremarkable.”  A pulmonary function test (PFT) performed as part of her evaluation revealed an FEV-1 and FEV-1/FVC of greater than 100% each.

At the 15 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month before TDRL removal, the CI reported she was taking Singulair 10 mg once a day, albuterol 2 puffs twice a day, and Flovent 2 puffs once in the morning.  Spirometry was identified as within normal limits.  At a subsequent C&P examination on 30 July 2004, 2 months after TDRL removal, the examiner recorded that the CI was taking additional medications with the continuation of inhaled corticosteroids.  Other than the above three examinations, there was no record of medical treatment for an asthma condition in the case file available to the panel for the 2-year period before TDRL removal or the 1-year period after removal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing normal spirometry, use of intermittent inhalational bronchodilator, and no documentation of requirement or use of daily controller therapy.  The VA also rated the asthma condition 10%, coded 6602, based on C&P examinations 1 month before and 2 months after TDRL removal, citing intermittent inhalational or oral bronchodilator therapy.  

A 30% impairment 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 examinations in evidence reported use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed and used as noted by the TDRL examination medication profile and the C&P examiners.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator 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.  There was also no PFT evidence to support the 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 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 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016919, 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