RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01051
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Petroleum Heavy Vehicle Operator, medically separated for “asthma” with a disability rating of 10%.  

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 - 20040304	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20041015	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in May 2003 after experiencing episodes of wheezing.  On 20 April 2003, the CI was treated for bronchitis with an antibiotic, an expectorant, a cough suppressant, and albuterol (inhaled bronchodilator).  Subsequently, she was noted to have a questionable small right lower lobe infiltrate raising the possibility of pneumonia.  She received treatment for reactive bronchitis on 14 May 2003 with Serevent (inhaled bronchodilator), an antibiotic, an oral steroid, an expectorant, and fluids, which resulted in improvement by 21 May 2003.  On 30 May 2004, a primary care provider recommended the CI discontinue Serevent, use albuterol as needed, and start on Advair (steroid/bronchodilator).  

Pulmonary function studies on 9 September 2003 revealed pretreatment (three trials) FEV1/FVC results of 72%, 69%, and 68% and post-treatment results of 78%, 77%, and 80%, which were interpreted as “minimal to moderate disease substantially improved on/with bronchodilator treatment.”  On 19 September 2003, treatment with “albuterol only” was prescribed when the CI was confirmed to be pregnant.  At a 24 September 2003 primary care visit, the CI’s obstructive lung disease was noted to be aggravated by fuel fumes related to her military specialty and she reported chest tightness and constant coughing.  Current medications listed at the visit were: Serevent Diskus inhaler (1 puff twice daily) and albuterol oral inhaler (2 puffs orally three times daily as needed).  An October 2003 medication profile showed Severent and albuterol refills on 29 August 2003 and another albuterol refill on 20 October 2003.  

The 25 November 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of wheezing when exposed to petroleum fumes, dust, pollen or inhalants.  Physical examination showed no acute distress or audible wheezing.  At a 19 July 2004 primary care visit, 3 months after separation, the CI was started on Advair for asthma treatment.  During a 25 August 2004 emergency room visit for dyspnea (shortness of breath), she was treated with Xopenex (bronchodilator).   

At the 15 October 2004 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported intermittent cough and chest tightness with wheezing.  She was taking Advair every 12 hours and using her albuterol inhaler as needed.  Pulmonary function tests revealed FEV-1/FVC of 71% pre-bronchodilator and 76% post-bronchodilator, due to mild obstructive defect with a reduced flow.  A chest X-ray demonstrated no infiltrate, cardiomegaly, or pneumothorax.  The clinical diagnosis was reactive airway disease/asthma.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing use of albuterol as needed.  The VA rated the asthma condition 30%, coded 6602, based on the C&P evaluation 6 months after separation, citing FEV-1/FVC of 76% post-bronchodilator with use of Advair and albuterol.  A 30% rating requires "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 VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case based on the daily use of an inhalational bronchodilator (Serevent), albeit it was instituted prior to pregnancy, and despite a note to discontinue it during the pregnancy, the prescription was refilled as noted on the medication profile.  Advair was prescribed in May 2003, 3 months post-separation and post-partum, for the same condition demonstrating the continued need for an anti-inflammatory medication.  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 §4.96 and §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 20160920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018597, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to recharacterize 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 recharacterization 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