RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01612
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated for “asthma” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that her disability rating should be changed for her asthma, pulmonary sarcoid and glaucoma.  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 - 20040527	VARD – 20041103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	30%	20040727	
Sarcoidosis, Asymptomatic	Not Unfitting	Ocular Sarcoidosis	6846-6000	NSC	20040705	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in February 2001 for possible asthma.  Provocation testing (methacholine challenge) confirmed the presence of reversible airway obstruction consistent with the diagnosis of asthma.  On 24 December 2003, 7 months prior to separation, pulmonary function testing (PFT) showed an FEV-1 of 79% of predicted and an FEV-1/FVC of 88%.  Chest X-rays were normal.  

According to the 20 February 2004 pulmonary evaluation, 5 months prior to separation, the examiner noted that the CI was on Advair (inhalation steroid/bronchodilator combination) twice daily.  The examiner also prescribed a 4-week course of prednisone tablets (an oral steroid).  During the 16 April 2004 MEB examination (recorded on DD Form 2807-1 and 2808), 3 months prior to separation, the CI reported taking Advair.  Physical examination documented diffuse wheezes in the lungs with full breath sounds in all fields.  The NARSUM (dated the same day) also recorded that the CI was taking Advair twice daily.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

At the 27 July 2004 VA Compensation and Pension (C&P) evaluation, 2 days prior to separation, the examiner noted that the CI was taking Advair.  PFT showed an FEV-1 of 85% of predicted and an FEV-1/FVC of 86%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602, citing intermittent use of medication and non-compliance.  The VA rated the asthma condition 30%, coded 6602, citing daily use of medication.  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 NARSUM, STR and C&P examinations all supported that the CI was prescribed and used Advair.  Advair is an inhalational anti-inflammatory medication and the 30% rating does not specify daily use.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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.  

Contended PEB Condition:  Sarcoidosis, Stage 0.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  While the contended condition was profiled and implicated as limiting duties in the commander’s statement, it was judged to be “not disqualifying” by the MEB.  The commander’s statement indicated the CI had ocular symptoms in 2000.  The CI had a civilian provider’s evaluation for ocular symptoms, fatigue, and difficulty breathing which led to an MRI that showed granulomatous tissue in the lung area and indications that pulmonary sarcoid may be contributing to the CI’s problems.  Records proximate to separation documented that ocular symptoms had subsided to at most sensitivity to bright light and did not interfere with performance of duty.  The NARSUM indicated there was no evidence of active sarcoid, and PFT testing of lung diffusion capacity was normal (indicating no significant interstitial disease).  There were no ocular, or extra-pulmonary symptoms proximate to separation that rose to the level of being unfitting.  There were no clear indications that there was duty-limiting pulmonary sarcoidosis proximate to separation and any possible overlap of the CI’s sarcoidosis related to the lungs was considered under the above rating for the unfitting asthma condition.  In accordance with VASRD §4.96 where coexisting respiratory conditions exist, a single rating will be assigned that reflects the predominant disability:  In this case the asthma condition was clearly the predominant disability proximate to separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended sarcoidosis condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended sarcoidosis condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20161004, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002559, 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