RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01164
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20041105

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

CI CONTENTION:  Review all conditions.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040712	VARD - 20050831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Bronchospasm	6602	10%	Asthma	6602	NSC	20050511	
Left Knee Anterior Cruciate Ligament [ACL] Tear with Medial Meniscal Tear	Not Unfitting	Left Knee Status Post ACL Reconstruction with Scar 	5260	10%		
Right Knee ACL Tear		Right Knee Status Post ACL Reconstruction with Scar 	5260	10%		
Bilateral Knee Pain		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Exercise Induced Bronchospasm.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s exercise-induced bronchospasm condition began in 1996 after excessive wheezing during a physical readiness test (PRT).  She started using an albuterol (inhalational bronchodilator) prior to and after completing PRTs or exercising on her own, but after a PRT on 6 May 2004, she felt dizzy, nauseated, quite tired, and reportedly lost consciousness for a brief period before being resuscitated.  She was hospitalized overnight, and upon discharge, started on daily Singulair (oral indirect-acting bronchodilator), a 4-day supply of prednisone (steroid), and Azmacort (inhaled anti-inflammatory medication) to use as needed after the prednisone was stopped.  Shortly after, an MEB was initiated, with a diagnosis of exercise induced bronchospasm.  

The 20 May 2004 MEB NARSUM examination, 6 months prior to separation, noted that the CI was taking Singulair daily and albuterol as needed.  During the 3 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months before separation, the CI reported taking Flonase (nasal corticosteroid), Allegra (antihistamine), albuterol, and Azmacort, but frequency was not noted.  Pulmonary function test (PFT) results were not recorded on either examination, and there was no evidence of PFTs conducted during the 2-year period prior to separation.  

At the 11 May 2005 VA Compensation and Pension (C&P) general examination, 6 months after separation, the examiner reported the CI “does use inhalational anti-inflammatory medication as well as the inhalational medications that open up the windpipe,” but did not provide specifics regarding medications/dosage or a prescription list.  Measured PFTs showed an FEV-1 of 65% of predicted and an FEV-1/FVC of 88% of predicted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the exercise induced bronchospasm condition 10%, coded 6602 (asthma).  The VA did not service connect the asthma and chronic obstructive pulmonary disease, based on the C&P examination, citing that episodes were the result of exertion, with normal PFTs leading to a diagnosis of exercise-induced asthma (not considered a chronic condition warranting service connection).  Members noted that under code 6602, 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.”  The panel agreed that the reported use of daily oral bronchodilators and/or inhaled anti-inflammatory medications at MEB, NARSUM, and VA examinations, as well as the recorded FEV-1 of 65% predicted at the C&P examination, met the VASRD §4.97 threshold for a 30% rating.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least 3 per year) courses of systemic corticosteroids.  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 exercise induced bronchospasm condition, coded 6602.

Contended PEB Conditions:  Left Knee ACL Tear with Medial Meniscal Tear, Right Knee ACL Tear, and Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were noted on limited duty forms or implicated in the non-medical assessment (NMA).  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The commanding officer’s comments on the NMA stated the CI “has not been limited in her duties due to this current condition… She meets standard work performance.”  Panel members noted she underwent right knee ACL reconstructive surgery in August 2004, after the MEB was completed and prior to separation, but an orthopedic clinic note on 15 October 2004, 3 weeks before separation, documented that she had recovered well post-operatively and regain full knee ROM without pain or instability.  She had also successfully performed duties as a hospital corpsman for years since a left knee ACL reconstruction in 1997.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the exercise induced bronchospasm condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended left knee ACL tear with medial meniscal tear, right knee ACL tear, and bilateral knee pain conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Exercise Induced Bronchospasm	6602	30%	

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs) COMMANDER, NAVY PERSONNEL COMMAND

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

   Ref:	(a)	DoDI	6040.44		
	(d)	PDBR	ltr dtd	12	Aug	18	ICO	XXXXXXXXXX		

1.	Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.  The official records of the following individuals are to be corrected as follows:

a.	XXXXXXXXXX: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

3.	Please take action to implement these decisions and provide notification to the above individuals once those are complete.