RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02111
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050817

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

CI CONTENTION:  Review all conditions. 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 - 20060822	VARD - 20060602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20060216	
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 was initially diagnosed with asthma in 1999 by an allergist which was confirmed by a pulmonology evaluation in 2001.  He was separated and placed on the TDRL on 18 August 2005. 

At the 16 February 2006 VA Compensation and Pension (C&P) examination, 7 months before separation, the examiner noted normal lungs and stated that the CI brought results from an allergy test which showed he was allergic to trees, pollen, and dog and cat hair. Current medications were not documented, and pulmonary function tests (PFTs) showed an FEV-1 of 107% of predicted and an FEV-1/FVC of 101%.  

The 10 May 2006 TDRL NARSUM examination was accomplished 5 months prior to separation but written on 22 August 2006, 1 month before separation.  The examiner noted the CI had been prescribed Advair (inhalational steroid/bronchodilator combination) without mentioning frequency of use, and albuterol (inhalational bronchodilator) 3 times at night and usually in the morning.  An allergy clinic evaluation on the same day documented that he had been prescribed one puff of Advair twice a day in the past with the most recent prescription filled on 24 August 2005 (13 months prior to separation).  The provider noted no wheezing, rhonchi or decreased breath sounds, and recorded allergies to tree, grass, and weed pollen, as well as dust mites, cockroaches, dogs, cats, and molds.  An increased dose of Advair with four refills was prescribed in addition to albuterol with two refills.  Pulmonary functions tests, also, the same day, revealed FEV-1 of 97% of predicted and an FEV-1/FVC of 99%, and were interpreted as normal spirometry with a bronchodilator making no difference.  Review of the STR found no clinical encounters documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation, or exacerbations frequent enough to require monthly visits to a physician.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 10%, coded 6602 (asthma).  The PEB cited FEV-1 of 93% and intermittent inhaler use.  The VA rated the asthma 0%, coded 6602, based on the C&P examination, citing asymptomatic asthma and PFTs from an examination performed during February 2005.  Members noted that 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.”  Inhaled anti-inflammatories were prescribed, as noted by the TDRL NARSUM examiner, and thus the panel agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case.  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 evidence of PFT findings, respiratory failure, hospital admissions, continued requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits to warrant a rating higher than 30%.  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 at the time of TDRL removal.  

BOARD FINDINGS:  In the matter of the asthma, the panel 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 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190005970, 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