RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00994
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Radio and Communications Security (COMSEC) Repairer, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.  

CI CONTENTION:  Current conditions have worsened and affect daily activities.  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 - 20080814	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s asthma condition began in August 2006 with sudden onset of inability to breath while performing a routine PT run.  The CI was placed on TDRL on 18 August 2007.  On 11 March 2008 the CI sought additional treatment for her asthma.  She was experiencing back pain when she took a deep breath.  Medications listed included Advair (inhalational anti-inflammatory), Albuterol (inhalational bronchodilator) and Singulair (montelukast - oral indirect-acting bronchodilator).  The CI reported she was using Albuterol in the morning and at night and was to continue Advair and Albuterol.  Pulmonary function tests (PFTs) revealed an FEV-1 of 81% of predicted and an FEV-1/FVC of 62% following bronchodilators.  

The medication profile showed the CI obtained Advair in September 2007, October 2007, and April 2008; Montelukast in December 2007, April 2008 and June 2008; levalbuterol (inhalational bronchodilator) in September 2007, and Albuterol in April and June 2008.  Pharmacy records show the CI filled a prescription for Symbicort (inhalational anti-inflammatory medication) on 16 June 2008.  

On 17 June 2008 (2 months prior to TDRL removal), PFTs showed an FEV-1 of 93% of predicted and an FEV-1/FVC of 65%.  The internal medicine cline appointment for PFT interpretations stated “suggestive of moderate obstructive impairment with poor response to BD (bronchodilator) treatment.”  Active medications included Albuterol and montelukast both filled the day before and Salmeterol (inhalational bronchodilator) last filled on 30 April 2008.  

The 19 July 2008 TDRL MEB NARSUM examination, 2 months prior to TDRL removal, noted complaints of continued difficulty breathing.  The CI reported her medications were just changed and she was taking Symbicort, two puffs daily, Singulair and Albuterol.  She denied emergency room visits.  The examiner referred to the above PFT results.  Physical examination noted normal breath sounds and no wheezing.  The examiner stated her condition had not changed from discharge and she was not stable and felt additional time was needed to see if the new medication would help her condition.  There was no VA examination in evidence proximate to TDRL removal.  The only VA examination in evidence was 1 month prior to TDRL placement which was also 10 months prior to TDRL removal.

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 10%, coded 6602 (bronchial asthma).  The PEB cited intermittent use of controller medications.  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 PFTs in evidence proximate to separation documented an FEV-1/FVC of 65 percent warranting a 30% rating.  Panel members also considered that the examinations in evidence reported a current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed, as noted by the 16 June 2008 prescription for Symbicort and the NARSUM.  The CI was prescribed Advair for daily use.  Advair, in addition to being an inhalational bronchodilator (salmeterol), also contains an inhalational anti-inflammatory medication (fluticasone), and would therefore warrant a 30% rating (even if not used on a daily basis).  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of PFTs 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 at the time of TDRL removal.

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97, at the time of removal from TDRL and permanent disability disposition. 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 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 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005226, 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