RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00913
BRANCH OF SERVICE:  ARMY 	DATE REMOVED FROM TDRL: 20030620

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

CI CONTENTION:  Her current condition supports higher rating.  The 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 - 20030506	VARD - 20020727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20020318	
RATING:  10%	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’s asthma condition began in 2001 when she had difficulty breathing with exercise and in dusty environments.  The CI was placed on the TDRL in June 2002 with asthma rated at 30% at which time she took medications including Advair (fluticasone/salmeterol, a steroid/bronchodilator), Zyrtec (cetirizine, an antihistamine), Singulair (montelukast, an indirect bronchodilator), Flonase (fluticasone, a steroid) nasal spray, and albuterol (a bronchodilator).  Other than the TDRL re-evaluation examination in February 2003, there were no records available to the panel showing treatment for asthma for the period from TDRL placement until TDRL removal in June 2003, or for the year after removal. 

At the 17 April 2002 VA Compensation and Pension (C&P) evaluation, 14 months before TDRL removal (and 2 months before her initial separation from the service), the CI reported taking albuterol, Advair, Flonase, Zyrtec, and Singulair.  Pulmonary function tests (PFTs) showed an FEV-1 of 90% of predicted and an FEV-1/FVC of 64.6%.  

At the 27 February 2003 TDRL re-evaluation, 4 months prior to TDRL removal, the CI indicated she was using her albuterol inhaler every other month for asthmatic attacks and Zyrtec daily for a dust mite allergy.  Physical examination revealed watery eyes with congestion and a few scattered wheezes in the lungs.  A chest X-ray dated 28 February 2003 revealed a small nodular density overlying the right breast.  PFTs on 1 March 2003 showed a mild obstructive process with good response to bronchodilators and a minimal decrease in diffusion.  Though there were no quantitative measurements available for review, spirometry results 14 months before TDRL removal were basically the same with a mild obstructive ventilator defect.  In that case the pre-bronchodilator FEV1/FVC ratio was 59.4% and the post-bronchodilator FEV1/FVC ratio was 64.6%. A VA medication profile transmission time-stamped 30 April 2003 showed  only issuance of albuterol, but no other asthma medication from 5 June 2002 (prior to placement on the TDRL) to 21 April 2003 (2 months after the TDRL evaluation).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing intermittent use of medications.  The VA rated the asthma condition 30%, coded 6602 (asthma), based on the C&P examination 14 months before TDRL removal, citing an FEV-1/FVC ratio of 64.6% after bronchodilation.  

A 10% rating requires “intermittent inhalational or oral bronchodilator therapy.”  Panel members agreed the PEB’s 10% rating was not unreasonable based on the intermittent use of inhaled bronchodilator therapy reflected in the TDRL re-evaluation.  Although it was determined the CI was prescribed albuterol for daily use (prior to initial separation and again after the TDRL re-evaluation, but prior to actual TDRL removal), the evidence makes clear that the CI did not engage in daily use of the medication.   Therefore, panel members determined a 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  Likewise, there was no evidence of PFT measurements proximate to TDRL removal (i.e. FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent) to warrant a 30% rating.   However, panel members noted the most recent PFTs on record, even though not proximate to separation, had a high probative value, which reflected an FEV-1/FVC ratio that met the 30% rating requirement.  As such, members noted the CI should not be burdened by inadequate documentation of PFT measurements since the PEB had the opportunity to ensure that details of that study were available for its adjudication.  In consideration of reasonable doubt (§4.3), the panel concluded there was not a preponderance of the evidence to favor the 10% rating over the 30% 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, 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 20160923, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018434, 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