RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01565
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Food Service Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma with intermittent use of inhaled steroids and albuterol” with a disability rating of 10%.  

CI CONTENTION:  He requested all conditions be reviewed.  He also contended that his TDRL physician recommended he stay on the TDRL; that he was not well represented; that he had to repay his severance pay; and that he had other conditions that should be rated.  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 - 20040511	VARD - 20060321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma with Intermittent Use of Inhaled Steroids and Albuterol	6602	10%	Bronchial Asthma with Chronic Bronchitis	6602	30%	20060201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma with Intermittent Use of Inhaled Steroids and Albuterol.  According to the service treatment record (STR), the CI was placed on the TDRL in July 2002 with asthma rated at 30%.  VA treatment records reflect that he was treated at a VA Medical Center on several occasions while on the TDRL.  Pulmonary function testing (PFTs) on 7 March 2003, 16 months before TDRL removal, showed an FEV-1 of 99% of predicted and an FEV-1/FVC of 104%.  PFTs in October 2003, 9 months before TDRL removal, showed FEV-1 of 100% of predicted and FEV-1/FVC of 99%.  

At the 5 February 2004 TDRL Evaluation, 5 months prior to separation, PFT results were FEV-1 of 75% of predicted and an FEV-1/FVC of 81% of predicted.  The examiner was silent regarding medication usage.  The PEB returned the TDRL Evaluation to the medical treatment facility to obtain a medication profile, which was submitted to the PEB on 26 April 2004.  It reflected the CI was prescribed montelukast (an oral bronchodilator) 10 mg to be taken once daily and last refilled on 9 April 2004, and flunisolide (an inhaled anti-inflammatory) prescribed for 2 puffs twice daily and last refilled on 23 February 2004.  

There was no VA Compensation and Pension evaluation proximate to TDRL removal in evidence.  Review of VA treatment records for the period after TDRL removal reflected continued prescription of montelukast to be taken daily, and flunisolide to be taken twice a day.  A 12-month supply of flunisolide was prescribed on 17 September 2003 and again on 14 April 2005, suggesting frequent, but not daily use.  

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 inhaled steroids and albuterol.  The VA rated the asthma condition 30%, coded 6602, (asthma), based on the C&P examination 18 months after TDRL removal, citing daily use of Albuterol, Flunisolide, and Singulair.  

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.”  Panel members considered that the medication profile submitted by the MTF subsequent to the completion of the TDRL Evaluation, along with later VA medication profiles, reported current prescription and daily use of bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed/used during the entire TDRL period and afterwards.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or inhalational anti-inflammatory medication use.  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 three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% 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 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 with Intermittent Use of Inhaled Steroids and Albuterol	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004649, 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 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), 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