RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00540
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle Crewmember, medically separated from the Temporary Disability Retired List (TDRL) for “history of asthma” with a disability rating of 0%.  

CI CONTENTION:  “I still have asthma and require medicine daily.  I also require a steroid inhaler as well.”  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 - 20060824	VARD - 20060201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Asthma	6602	0%	Asthma	6602	30%	20051115	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

History of Asthma.  According to service records, the CI was placed on the TDRL in February 2001 for asthma rated 30%.  He underwent a TDRL re-evaluation in March 2003, based on an examination done on 21 October 2002, and was retained on the TDRL because the PEB determined his condition had not stabilized.  He also underwent a TDRL re-examination in August 2004, but it appears that evaluation was not followed with PEB findings, so he remained on the TDRL.  

The 22 March 2006 TDRL re-examination most proximate to his separation date, one month after separation, noted the CI’s history of wheezing while running and performing physical activities, especially in high temperatures or on high pollution days.  Allergy testing was significant for grass, weeds, molds, cats, and mites.  He also had episodic reflux treated with calcium carbonate.  The CI reported using an albuterol inhaler (a bronchodilator) twice daily and Advair (an inhalational steroid/bronchodilator combination) twice daily.  Physical examination showed his lungs to be clear to auscultation.  The examiner reported pulmonary function tests (PFTs) in August 2005 which showed an FEV-1 of 71% predicted and an FEV-1/FVC of 79% with FEV-1 improvement of 4% with bronchodilator.  The examiner noted the CI had ongoing asthma and continued to require ‘as needed’ albuterol about twice per day along with Advair. The Advair dose was discussed with a recommendation to increase it, but the CI did not want to do this.  

At the 15 November 2005 VA Compensation and Pension (C&P) examination, 3 months before TDRL removal, the CI reported taking Advair daily and two puffs twice daily as needed of albuterol.  A chest X-ray revealed clear lung fields without evidence of a pleural or parenchymal lesion and no active disease.  No physical findings were reported related to the lungs.  Post-bronchodilator PFTs showed an FEV1 of 92% predicted and an FEV-1/FVC ratio of 83%.  The results were consistent with obstructive lung disease and mildly reduced diffusing capacity.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602 (asthma), citing wide gaps in the use of medications and lungs that were clear on examination.  The VA rated the asthma condition 30%, coded 6602 (asthma), based on the C&P examination, 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.”  Panel members considered that the examinations in evidence including the TDRL re-evaluation and VA examination reported the requirement for and use of a daily bronchodilator as well as an inhaled anti-inflammatory medication/bronchodilator combination.  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 also 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 20160216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006521, 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), XXXXXXXXXXXXXXXXXX.

	I copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure