;:J 1 15 2018

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve A£fairs) COMMANDER, NAVY PERSONNEL COMMAND
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 
Ref:  (a) DoDI 6040.44
(b)	PDBR ltr dtd 01 Oct 18 ICO XXXXXXXXXX

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

a.	XXXXXXXXXX, former USMC: 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 actions are complete.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00038
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Vehicle Operator, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060711	VARD - 20070129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20061120	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma condition began in March 2004 when he complained of dyspnea on exertion for the previous year.  He was referred to the pulmonary clinic where his baseline spirometry was normal but a methacholine challenge showed a 60% drop and he was diagnosed with asthma, worsened with exercise.  He was placed on limited duty, and a 21 June 2004 primary care clinic treatment note showed medications including albuterol (inhaled bronchodilator) and Advair (inhalational anti-inflammatory).  At a follow-up pulmonary clinic appointment on 22 September 2005 the examiner noted the CI was feeling a lot better since taking Advair and as-needed albuterol prior to running.  
There was no further record of treatment for asthma until dictation of the 2 June 2006 MEB NARSUM by the pulmonary clinic.  At this time the CI again complained of shortness of breath, chest tightness, coughing with exercise and an inability to run his physical readiness exercises in the required time.  Pulmonary function tests (PFT) conducted that day showed an FEV-1 of 85% of predicted and an FEV-1/FVC ratio of 79%.  The NARSUM listed daily use Advair and as-needed albuterol; however, the treatment note for that date reflected that Advair had been last filled on 4 August 2005 (10 months earlier) and still had 3 refills remaining, and his albuterol had been last filled on 30 June 2005 (11 months earlier), again with 3 refills remaining.  The CI underwent a direct laryngoscopy on 21 June 2006, resulting in a prescription for Spiriva (inhaled bronchodilator).  On the same date his pulmonologist administered a methacholine challenge test that was noted as positive for exercise induced bronchospasm.  

During the 30 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported taking Advair and albuterol, with dosage and frequency not mentioned.  However, a treatment note on the same date from the MEB clinic listed only albuterol and Spiriva as current medications.  

At the 20 November 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner recorded the CI was taking daily Spiriva, daily Advair and as-needed albuterol.  PFTs taken by the VA on 9 November 2006 showed FEV-1 of 104% of predicted and FEV-1/FVC of 88%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA also rated the asthma condition 10%, coded 6602, based on the C&P examination, citing VASRD criteria and not specifying how the 10% rating was determined.  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 examinations in evidence reported a current prescription and use of inhaled anti-inflammatories.  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 (Advair) use and daily bronchodilator therapy (Spiriva).  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 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 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 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	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record