RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00766
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.

CI CONTENTION:  Used evidence supports a higher rating.  The complete submission is 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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  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 - 20041005	VARD - 20030730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20030630	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was placed on the TDRL in May 2003 with asthma rated at 30%.  The 30 June 2003 VA Compensation and Pension (C&P) evaluation, 1 month after TDRL placement and 15 months prior to TDRL removal, documented the CI utilized an inhaled corticosteroid Advair.  At the 20 July 2004 TDRL evaluation, 3 months prior to TDRL removal, the CI’s current medications included the continued daily use of daily Advair and Albuterol (inhaled bronchodilator) “frequently and at night.”  A medication profile submitted with the TDRL evaluation revealed that Advair and Albuterol were prescribed and filled on the same day; however, no corticosteroid prescription was documented.  Under the heading of “History of Present Illness” the examiner documented the CI’s statement that he (CI) had gone to the emergency room four times in the past year and took short courses of Prednisone (corticosteroid) seven times in the past year.  Physical examination was unremarkable and a pulmonary function test (PFT) performed as part of her evaluation revealed an FEV-1 of 76% predicted and an FEV-1/FVC of 82%.

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 and no daily therapy.  The VA rated the asthma condition 30%, also coded 6602, based on the C&P examination 1 month after TDRL placement, citing daily medication 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 agreed that the TDRL examination in evidence documented the prescription and daily use of inhaled anti-inflammatory (Advair) and frequent and nightly use of inhaled bronchodilator (Albuterol).  The daily use of inhaled anti-inflammatory is not required to support a 30% rating.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily inhaled bronchodilator or inhaled anti-inflammatory medication use.

Although the TDRL examination (history of present illness) documented the CI’s statement of utilizing Prednisone (corticosteroid) multiple times within 12 months of separation, the panel majority determined the post-TDRL placement STR and VA evidence did not document any additional asthma treatment, medication profile or emergency room evidence to support a 60% rating.  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 recommends a disability rating of to 60% and elected not to submit a 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017586, 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