RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00112
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Patriot Missile Crew Member, medically separated for “asthma” with a disability rating of 0%.  

CI CONTENTION:  Review requested of asthma and 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, 3575117may 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 - 20040513	VARD - 20050418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	10%	20050307	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was evaluated by pulmonary medicine in August 1993 and diagnosed with exercised-induced asthma and allergic rhinitis.  Treatment included corticosteroids and bronchodilators, but continued presentation of asthma symptoms lead to a permanent P3 profile and a scheduled MEB in 1999 that never occurred due to a change of station.  Persistent symptoms, especially in the field, led to the CI’s own request for MEB.  

At a German internal medicine clinic appointment on 19 May 2003, 15 months prior to separation, he complained of dyspnea (difficulty with breathing) since earlier in the day.  The examiner noted no cough or fever, and diagnosed acute bronchial asthma with a prescription for theophylline (oral bronchodilator) and prednisolone (synthetic corticosteroid) intravenously. 

At a pulmonary clinic visit on 6 August 2003, 12 months before separation, the provider noted normal spirometry, no significant response to bronchodilators, and normal lung volumes as well as diffusing capacity of the lung for carbon dioxide (DLCO).  Pulmonary function testing (PFT) showed an FEV-1 of 97% of predicted and an FEV-1/FVC of 108%.  The examiner also prescribed prednisone (corticosteroid) use only with no improvement on albuterol.  The prescription list that day noted both Advair (combination inhalational anti-inflammatory and bronchodilator medication) and albuterol (inhaled bronchodilator).  

At a 19 August 2003 primary care visit for breathing issues, the CI complained of chest pain for the previous 2 days and had taken asthma medications that morning.  Treatment consisted of oxygen for 30 minutes and instructions to take a prednisone taper if the condition reoccurred that day or evening.  At a follow-up appointment the next day, he was instructed to continue use of albuterol as required and continue the prednisone taper.  

At a 3 September 2003 pulmonary appointment for chest tightness, 11 months prior to separation, the CI complained of episodes of dyspnea the previous night and that morning.  Physical examination showed the lungs were clear to auscultation bilaterally, and the medication list included Advair, albuterol, montelukast (oral indirect-acting bronchodilator) and prednisone.  On 5 September 2003, a pulmonary clinic telephone consult documented that the CI was unable to control his asthma symptoms and the prednisone was not helping.  The physician’s note stated that although he was on maximal medications, his multiple asthma exacerbations required daily prednisone for 5 days followed by a visit to a pulmonologist the following week, or the emergency room if the condition worsened.  The STR medication profiles showed the CI was prescribed an additional 5 days of prednisone as well as Advair, albuterol and montelukast.  

During the March and April 2004 MEB examinations (recorded on DD Forms 2807-1 and 2808), 4-5 months prior to separation, the CI reported shortness of breath (SOB), chest pressure and tightness related to asthma, inability to complete training due to dust and weather induced flare-ups, and asthma-related hospital stays.  Additionally, he check marked asthma problems, SOB, use of an inhaler, chronic cough, sinusitis and hay fever on the DD Form 2807.  The examiner noted a diagnosis of asthma.  

The 7 April 2004 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of severe episodes of dyspnea on exertion as well as SOB due to asthma and worsened by field deployments; he felt unable to perform his duties as a soldier.  The provider referred to MEB examination findings.  

At the 22 February 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported wheezing and dyspnea on exertion at least 3 times a week as well as SOB which woke him from sleep; he used albuterol and Advair on a daily basis.  Physical examination showed distant bilateral upper lobe breath sounds which were clear at the bases, and no rales, wheezing, rhonchi or reproducible anterior chest wall pain.  A PFT addendum on 7 March 2005 showed an FEV-1 of 110% 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 (asthma), citing non-compliance with medical management.  The VA rated the asthma condition 10%, coded 6602, based on the C&P examination, citing medication use.  Members observed that multiple examinations in the STR reported inhaled anti-inflammatories were prescribed and used proximate to separation, and therefore agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied 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.  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 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 20170115, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012732, 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,