RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01719
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmission Systems Operator, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  “Pulmonologist stated I refused treatment before he deployed.  I never refused said treatment.”  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 - 20040429	VARD - 20041108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20040910	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in June 2003 when he started experiencing chest pain, light-headedness, shortness of breath, and difficulty breathing during an Iraq deployment.  He was medically evacuated and was seen on 9 July 2003 by a pulmonologist.  The pulmonologist reported normal pulmonary function tests (PFTs) and the physical examination was unremarkable.  A chest X-ray on 11 June 2003 showed no pulmonary infiltrates.  The examiner continued him on his medications, which were Advair (inhaled steroid and bronchodilator) and albuterol (inhaled bronchodilator) as needed.  

A specialty care consult for the MEB dated 23 January 2004, 8 months before separation, reported the CI was taking Advair, Singulair (considered an oral bronchodilator for VA rating purposes), and albuterol as needed.  PFTs from 23 September 2003 were reported as FEV-1 of 138% of predicted and an FEV-1/FVC ratio that was normal.  

During the 12 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported taking albuterol, Advair and Singulair, but did not identify the dosage or frequency of use.  The 25 February 2004 MEB NARSUM examination, 7 months prior to separation, repeated the PFT measurements noted in the 23 January 2004 specialty care consult and also noted the CI was taking Advair, Singulair, and albuterol.  PFTs taken on 16 April 2004 showed an FEV-1 of 69.9% of predicted and an FEV-1/FVC ratio of 79.66.  A pulmonology clinic appointment on 30 April 2004 also noted the CI was taking Advair, Singulair, and albuterol.  

At the 10 September 2004 VA Compensation and Pension (C&P) evaluation, 10 days before separation, the examiner noted the CI required inhalation of anti-inflammatory medication, bronchodilator by inhalation daily, and bronchodilator by mouth daily.  Specific medications were not named.  PFTs showed an FEV-1 of 96% of predicted and an FEV-1/FVC of 82%.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injected) steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

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 medication on an intermittent basis.  The VA rated the asthma condition 30%, coded 6602, (asthma), based on the C&P examination 10 days before separation.  

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 C&P examination, which was most proximate to separation, reported a current use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed and used, as noted by the specialty care, MEB, and VA examiners.  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 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	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161005, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170019802, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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