RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01002
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20051014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E4, Automated Logistical Specialist, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  The CI contended to have post-traumatic stress disorder (PTSD) and other medical diagnosis from my service in the military.  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 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 - 20041025	VARD - 20070326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20051210	
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 presented to the Pulmonary Clinic on 13 September 2004 with complaints of exertional shortness of breath since arrival at Ft. Hood for deployment training.  The CI reported episodes of recurrent bronchitis with worsening symptoms since mobilization in March of 2004.  The 7 April 2004 (8 months prior to separation), pulmonary function testing (PFTs) showed an FEV-1 of 93% of predicted and an FEV-1/FVC of 67% after bronchodilator medication.  During the 20 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported taking Singular for asthma first diagnosed in September 2004.  Physical examination showed a clear chest with normal respiration.  
At the 5 October 2004 MEB NARSUM examination, 12 months prior to separation, the CI reported using Singulare 10 mg daily, Aciphex 20 mg daily, Atrovent 2 puffs twice a day.  The CI additionally reported a trial of prior steroid therapy.  However, the inhaled steroids made her ill.  The CI complained that running and wearing of the protective mask made her symptomatic.  The examiner noted the CI was smoking approximately ½ pack of cigarettes per day.  Physical examination showed the lungs were clear to auscultation.  Spirometry performed on 13 September 2004 revealed a mild obstructive defect and no change with bronchodilators.  FEV1 was 80% predicted and FEV1/FVC was 61% pre and post Rx.  Chest radiographic (X-ray) studies and high resolution computed tomography (CT) scans performed in July 2004 were both grossly normal.  The examiner closed with “current clinical condition of this service member is one that does not require the use of daily controller medications.”  The patient was to use Atrovent 2 puffs every 4 hours as needed.  

At the 10 December 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported intermittent periods of shortness of breath, chest pain and occasional cough with no symptom-related hospitalization.  The CI stated she was taking no asthma medications because her supply was exhausted.  The CI’s medical record was unavailable to the examiner and it was recorded that “no evidence today to suggest that she has any active asthma today in clinic.”  Subsequently, the CI reported for a respiratory VA examination on 1 June 2006, 18 months after separation, which recorded moderate airway obstruction with partial reversibility after bronchodilator.  The PFT results showed FEV-1 of 84% and FEV1/FVC of 75%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing FEV-1 80%, 85% after inhaled bronchodilator and on intermittent inhalational bronchodilator therapy.  The VA also rated the asthma condition 10%, coded 6602, (asthma, bronchial), based on the C&P examinations 12 and 18 months after separation, citing “intermittent use of inhalation therapy.”  

A 30% rating stipulates a “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 a 30% rating was justified by the FEV-1/FVC of 61% based on the 13 September 2004 PFT and noted by the NARSUM examination.  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 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 20160911, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018563, 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