RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01097
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060629

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

CI CONTENTION:  She should have received a higher rating (medical retirement) for her asthma.  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 - 20060616	VARD - 20060905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing shortness of breath in 2003, and was formally diagnosed with asthma by a pulmonologist in March 2004.  She was separated and placed on the TDRL on 16 June 2005.  On 17 January 2006, 5 months prior to TDRL removal, the CI underwent pulmonary function testing (PFT) which showed FEV-1 of 96% of predicted and an FEV-1/FVC of 78%.  These were noted to be consistent with a mild obstructive defect (asthma); there was minimal improvement with medications.  The 8 June 2006 TDRL NARSUM examination, 3 weeks prior to TDRL removal, noted that while the CI had been prescribed an inhalational steroid (Advair) and an oral indirect-acting bronchodilator (Singulair), she had run out of medications and was taking only an inhalational bronchodilator (albuterol) for rescue from asthma every night.  It was also noted that she had 10 dogs and continued to smoke cigarettes.  The examiner continued the albuterol prescription and reintroduced treatment with the inhalational anti-inflammatory (Advair) and oral indirect-acting bronchodilator (Singulair).  PFTs done that same day (8 June 2006) showed an FEV-1 of 96% of predicted and an FEV-1/FVC of 91%.  The medical records show that the CI refilled the prescriptions for Advair, Singulair, and albuterol that same day.  

Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) 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.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.  At the 12 May 2007 VA Compensation and Pension (C&P) examination, 10 months after separation, the examiner noted the CI was taking no medications because she had run out of them.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing an FEV-1 of 96%, not requiring daily controller medications, and having 10 dogs as pets.  The VA rated the asthma condition 30%, coded 6602, based on the STR, noting the use of daily medications on a clinical note dated 10 December 2004.  Later, the VA reduced the rating to 0%, based on the 12 May 2007 VA examination, citing there was no current treatment of the condition and or failure to show up to another scheduled examination.  

Panel members considered that the TDRL NARSUM examination, which was most proximate to the date of removal from the TDRL, reported a current prescription and use of a daily bronchodilator.  Inhaled anti-inflammatories were also required and prescribed, as noted by that same examiner.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied on the basis of inhalational anti-inflammatory medication.  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.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  The panel observed that while the asthma condition was likely aggravated by both cigarette smoking and the number of pets, this is speculative and a deduction is not supported by the VASRD.  Compliance with medication use was also problematic, but again a deduction for this is not permitted by the VASRD.  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 at the time of TDRL removal.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97, at the time of removal from TDRL.  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, 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 2017221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004771, 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.

Sincerely,					      
Enclosure