RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01294
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O1, Officer Trainee, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.  

CI CONTENTION:  Contended for a higher rating.  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 - 20040224	VARD - 20021018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20020919	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in April 2001 after complaints of experiencing dyspnea on exertion.  A diagnosis of mild intermittent asthma was made on a pulmonary function test (PFT) of FEV1 80% predicted and FEV1/FVC ratio of 68% predicted and results of a methacholine challenge test which were positive for bronchial hyperactivity.  The CI was subsequently placed on the TDRL.  

At the 19 September 2002 VA Compensation and Pension (C&P) evaluation, 18 months before TDRL removal, the CI reported having an asthma condition for a period of 2.5 years.  It was also noted that he had vocal cord dysfunction which caused shortness of breath (SOB) with heavy exercise.  The CI reported a weight gain of 60 pounds over a 2-year period which he attributed to the oral steroids he took.  The physical examination showed that the 69-inch tall CI weighed 279 pounds.  His lungs were clear and there was no respiratory distress.  PFTs were normal.  

PFTs done on 26 June 2003 showed FEV1 and FEV1/FVC ratio of 89% and 99%, respectively, after bronchodilators.  The pre-bronchodilator values were also normal.  A medical profile that day showed that he was on daily Singulair and a rescue inhaler.  The last prescription for inhaled steroids was filled on 26 September 2001.  There was no evidence that he had been given an oral steroid.  

The TDRL removal evaluation was accomplished on 12 September 2003 by his treating pulmonologist.  It noted no oral steroid use for the past year and that he had not been hospitalized.  He reported the use of daily medications including an inhaled steroid.  He was well controlled for his asthma but still could not run 2 miles.  The vocal cord dysfunction was treated in speech therapy.  An informal PEB dated 22 October 2003 recommended removal of the CI from the TDRL with a 10% rating, noting that the medical profile did not show that he had received an inhaled steroid and that he used the rescue inhaler intermittently.  Following the Informal PEB, a medical profile dated 22 December 2003 showed that he had obtained new prescriptions for Singulair as well as Flovent, an inhaled steroid.  

The panel directed attention to its rating recommendation based on the above evidence.  The formal PEB rated the asthma condition 10%, coded 6602 (asthma), citing FEV-1 80% after inhaled bronchodilator and intermittent inhalational therapy.  The VA also rated the asthma condition 10%, coded 6602 (asthma), based on the C&P examination 18 months before TDRL removal, citing FEV-1 of 71 to 80 percent of predicted value.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Panel members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the NARSUM and C&P evaluations.  A 10% rating was also justified by FEV-1 of 71 to 80 percent predicted and/or the FEV-1/FVC of 71 to 80 percent noted by the NARSUM and C&P examinations.  However, the use of an inhaled steroid supported a 30% rating.  The panel observed that the CI contended that his medical rating should be reviewed, but did not specifically contend for the vocal cord dysfunction and it is therefore outside the scope of the panel.  The vocal cord dysfunction was determined to be not unfitting by the initial PEB.  The panel noted that while this might have contributed to his symptoms, it was not severable from the underlying asthma condition.  Regardless, the PFTs in evidence did not support a compensable rating.  Even were it within the scope of this panel and found to be separately unfitting, this would provide no rating advantage to the CI.  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, 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 20160921, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001946, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 payment.  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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure