RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00687
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “asthma” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040604	VARD - 20041007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	30%	20040701	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced shortness of breath (SOB) and dyspnea upon exertion beginning in December 2003.  He was thought to have exercise- induced bronchospasm and given an inhaler as well as a referral to pulmonary medicine.  There he was noted to have asthma based on pulmonary function testing (PFT) in January 2004.  He was initially prescribed Albuterol (inhaled bronchodilator) on an ‘as needed’ basis, but was later also placed on a steroid inhaler.  

On 15 January 2004, 8 months prior to separation, PFTs showed an FEV-1 of 72% of predicted and an FEV-1/FVC of 60%.  Repeat testing on 5 February 2004 showed an FEV-1 of 83.9% of predicted and an FEV-1/FVC of 82.7%, which was graded as severe based on the poor values prior to the use of a bronchodilator.  

At the 8 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported SOB and wheezing.  The CI listed “N/A” for current medications.  The lungs were clear to auscultation bilaterally on physical examination.  The 8 April 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of SOB with exertion and exposure to cold temperatures.  It was also recorded that the CI did not respond to inhalers.  The panel observed that this statement is not consistent with the response shown on the PFTs in evidence.  The CI reported taking no medications on the DD Form 2807-1 the same day.  

According to the 27 April 2004 pulmonologist consult 3 weeks later, the CI was taking Albuterol as needed.  Wheezes were present.  The PFTs showed a pre-bronchodilator FEV-1 of 42% predicted and FEV-1 ratio 65% predicted.  These were interpreted as a mixed defect with low FVC and an obstructive ventilator defect graded as severe.  Post-bronchodilator challenge showed an increase of 53% in FVC (to 64%) and 96% improvement in FEV-1 (to 127%) which was consistent with asthma with a very marked response to bronchodilator therapy.  The CI was prescribed an 8-day prednisone burst along with Advair (daily) and Albuterol (as needed).  This was the only evidence found which documented the use of an oral steroid for asthma in the year prior to separation.  

At the 1 July 2004 VA Compensation and Pension (C&P) evaluation, over 3 months before separation, the CI reported a history of wheezing and SOB after a 3-hour exercise program for Special Forces training.  The CI reported taking Albuterol prn (as needed) and Advair two puffs twice a day.  The physical examination revealed normal lungs with no wheezing or crackles.  The PFTs done on 7 July 2004 were interpreted as showing mild airflow limitation which was unchanged with bronchodilator use.  Also documented were FEV-1 of 60% of predicted and an FEV-1/FVC of 59%.  The panel observed that the pre-bronchodilator values were 70% and 71%, respectively.  The examiner stated the patient did not perform tests well, reducing the probative value of the examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602 (asthma, bronchial), citing the CI self-reporting he was not using any medications at the MEB DD 2807-1 and 2697.  The VA rated the asthma condition 30% coded 6602, based on the C&P examination approximately 3 months before separation, citing daily use of Advair and FEV1/FVC of 71 percent.  

The panel observed that although the CI reported he did not use medications on the DD Form 2807-1, he subsequently did report their use at the C&P examination which was also prior to, and more proximate to separation.  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.”  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed as noted by the pulmonologist.  The panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case.  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, 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016359, 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