RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00751
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041022

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

CI CONTENTION:  “My injury has gotten progressively worse.  Now I have severe back pain and migraine headaches. The VA doctor will not prescribe medication to help me.”  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 - 20040630	VARD - 20050120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20041207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in April 2003 with shortness of breath.  A diagnosis of exercise induced asthma was made that same month and the CI was started on albuterol (inhalational bronchodilator).  On 3 April 2003, 18 months prior to separation, pulmonary function testing (PFTs) showed an FEV-1 of 85% of predicted and an FEV-1/FVC of 83%.  The 23 April 2004 MEB NARSUM noted that on 12 June 2003, 16 months prior to separation, the CI presented with shortness of breath on exertion and was continued on Singulair (an oral, indirect-acting bronchodilator) daily and albuterol (an inhalational bronchodilator) two puffs up to 4 times per day.  The NARSUM gave no other reference to medication use or prescription.  

During the 18 June 2004 MEB examination (recorded on DD Forms 2808 and 2807-1 and 2697), 4 months prior to separation, the CI reported that he was using an inhaler along with non-asthma medications of Flonase and Claritin, but did not mention use of Singulair.  A review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  At the 7 December 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the examiner noted that the CI was taking Singulair daily and albuterol twice daily.  PFT’s were not performed, but the examiner noted the results of the 3 April 2003 in-service PFT.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing PFT results and intermittent bronchodilator therapy.  The VA also rated the asthma condition 10% using the same code (6602) citing the C&P quotation of the 3 April 2003 in-service PFT.  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 examinations in evidence reported a then-current prescription and use of daily bronchodilators.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent submitted the appended minority opinion.  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 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Minority Opinion:  The majority believes that there is satisfactory evidence to support a 30% asthma rating for daily inhalational or oral bronchodilator therapy.  The CI did not meet the criteria for a 30% rating and the evidence supports the 10% asthma ratings by both the service and VA.  The STR showed that the CI was prescribed Albuterol, which is an inhalational bronchodilator, but the medication profile showed that since his diagnosis of asthma, he had only two prescriptions of Albuterol filled (1 April 2003 and 12 June 2003), which is consistent with intermittent use of an inhalational bronchodilator.  The STR also showed that the CI was prescribed Montelukast (Singulair), which is considered an oral bronchodilator for rating purposes.  The medication profile was mostly consistent with the NARSUM history that showed the CI being prescribed Singulair on 12 June 2003, but the aviation clinic note, dated 12 June 2003, showed that the CI was to be started on Singulair, 10 mgs, once a day for 30 days and not “continued on Singulair.”  The 9 July 2003 aviation medicine clinic note indicated “cont. meds,” but there was no evidence of a prescription fill for Singulair in the case file on or near this date.  The next applicable STR, dated 19 September 2003, was for a physical profile change to allow him to run at his own pace and distance and not have to perform the run event on the Army Physical Readiness Test.  There was no mention of any medication use or prescription.  At the 15 January 2004 aviation medicine clinic appointment a new prescription was made for Flonase and the examiner also indicated that the CI was to “cont. Singulair.”  The medication profile reflects the addition of the Flonase prescription and fill on 15 January 2004, but does not show any refill or new prescription of the Singulair.  The 18 June 2004 MEB Medical History (DD Form 2807-1) reflects in block 8 that the CI reported that his current medications were “Inhaler” and “Flonase,” the CI did not mention that he was using Singulair or Montelukast.  Both the PEB and VA rated the asthma condition 10% and the evidence in the case file does not support the majority’s recommendation of 30% for daily use of Singulair.  The minority voter accordingly recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

AR20170017485, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and recommended that your percent of disability be increased to 30%.  I have reviewed the Board’s record of proceedings, majority recommendation, and minority opinion (copy enclosed).  I regret to inform you that I reject the Board’s majority recommendation and accept the Board’s minority opinion as accurate that your final Physical Evaluation Board disability rating remains unchanged.  There is insufficient justification to support the Board’s recommendation in accordance with Army and Department of Defense regulations.

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,

Enclosure