RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02160 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20041113

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Signals Intelligence Analyst, medically separated for “asthma with vocal cord dysfunction” with a disability rating of 10%.

CI CONTENTION: “She has widespread, severe joint pain that interferes with ADL’s and ability to sustain employment CI also has moderate OA of both knee.” 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 - 20040917	VARD - 20041108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma with Vocal Cord Dysfunction	6602	10%	Asthma	6602	10%	20040407	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Asthma. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma condition was clinically diagnosed by a positive methacholine challenge test in June 2004 noting a greater than 20% decrease in FEV-1. Her physical complaints included exertional shortness of breath, chest tightness, and wheezing. She had been using an albuterol (bronchodilator) inhaler 2 to 3 times per day and reported nocturnal symptoms 4 times a week.

At the 7 April 2004 VA Compensation and Pension (C&P) examination, 7 months prior to separation, the general physical examination (PE) was normal. The CI’s diagnosis was documented as exercise-induced asthma rated as mild and intermittent.

During the 4 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI endorsed taking both albuterol and Advair. The MEB NARSUM examination 4 days later noted complaints of chest tightness, palpitations, wheezing, and lightheadedness with exertion. The CI reported using an albuterol inhaler with exercise. The provider documented, “[The CI] is currently using albuterol with exercise…The current clinical condition of this [CI] is one that does not require the use of daily controller medications.” Her diagnosis remained as mild intermittent asthma. A clinical document dated 14 October 2004, 10 weeks after the expected renewal date of the first Advair prescription that was received on 30 April 2004 and one month prior to separation, clearly listed her medications to include Advair, but also clearly listed that her last (and apparently only) prescription was last filled on 30 April 2004 with three refills remaining.

The panel directed attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the asthma condition 10%, coded 6602 (asthma), citing the use of intermittent inhalational bronchodilator therapy and PFT findings, respectively. The unequivocal VASRD code for rating asthma is 6602. VASRD §4.97 defines both spirometry-derived criteria and clinical treatment criteria for rating under 6602. The non-spirometry criteria is “intermittent inhalational or oral bronchodilator therapy” for 10%; and “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication” for 30%. The spirometry derived criteria is “FEV1 of 71 to 80-percent predicted, or; FEV1/FVC of 71 to 80 percent” for 10%, or “FEV1 of 56 to 70 percent predicted, or; FEV1/FVC of 56 to 70 percent” for 30%.

The CI’s continued use of an inhaled bronchodilator as a rescue medication does support a minimum of 10% rating and therefore is in agreement with the PEB’s current rating. However, the clinical treatment criteria underpinning the 10% and 30% ratings are the pivotal points for decision in this case. Panel members extensively deliberated over the medication profile indicating that with refills, the CI would have the Advair medication at least 5 months beyond separation. Although the medication profile noted the Advair as an active medication, all panel members concluded that the probative weight of the medication profile alone was out-weighted by clinical evidence found in the NARSUM whereby the provider clearly stated, “[The CI] is currently using albuterol with exercise” and additionally, the clinical note dated October 2004 noting the persistence of three refills remaining causing a calculated void of 10 weeks without Advair, if taken according to the healthcare provider’s instructions. Based on this rationale, the CI’s condition did not support greater than a 10% rating. A higher 30% rating was not justified in the absence of inhaled anti-inflammatories or an FEV-1/FVC less than or equal to 70% predicted. Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.

BOARD FINDINGS: In the matter of the asthma condition and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170103, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

PD-2017-02160 

AR20190012280, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      

Enclosure

PD-2017-02160