RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03073
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050110

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

CI CONTENTION:  “I still have asthma.  This condition is more severe than the rating issues.”  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 - 20041117	VARD – 20040305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first experienced shortness of breath (SOB) in April 2001, with progressively worsening symptoms.  On 18 October 2001, a methacholine challenge test was performed and was interpreted as a clear obstructive pattern that was relieved with bronchodilators.  The CI was diagnosed with asthma and eventually prescribed an anti-inflammatory inhalant medication (Advair), an oral bronchodilator medication (Singulair) and a bronchodilator inhaler (albuterol).  The CI was separated and placed on TDRL for asthma on 21 February 2003.  
At an asthma examination on 25 November 2003, the CI reported cough, wheezing and SOB.  He had been to the emergency room a week earlier and was started on antibiotics, but had not improved.  Physical examination of the heart and lungs was normal.  The eyes and nose showed signs of allergies.  The CI was given a steroid injection and he was prescribed daily Advair and albuterol, as needed.  

The 5 April 2004 TDRL re-evaluation, 9 months prior to TDRL removal, noted complaints of asthma and rhinitis.  The CI reported having been to the emergency room five times since November 2003.  The examiner noted the CI was typically prescribed tapering doses of oral steroids.  His last emergency room visit was in January 2004.  Physical examination showed the lungs were clear to auscultation.  Spirometry showed FEV-1 of 79% of predicted and FEV-1/FVC ratio of 84% predicted.  The examiner noted the CI’s asthma condition was not stable and recommended the CI remain on TDRL status and be re-evaluated in a year.  The CI’s medication profile showed prescriptions of albuterol, Singulair and Advair.  

At an allergy and asthma examination on 12 October 2004, 3 months prior to TDRL removal, the CI reported moving in January 2004 and had been doing well until the last two weeks when he was off his medications.  He reported wheezing, coughing and SOB were worse seasonally in the summer.  He reported emergency room visits for chest pain and SOB.  The examiner noted the CI did not routinely get steroids for flares since his initial diagnosis.  Previous allergy tests were noted to be positive for almost all items tested.  The CI had been on immunotherapy with benefit, but had been off for the past six months.  The physical examination of the heart and lungs was normal.  The CI was given a steroid injection and prescribed Advair daily and albuterol, as needed.  Physical examination of the heart and lungs was normal.  Pulmonary function testing (PFT) showed FEV-1 of 80% predicted and FEV-1/FVC of 79%, with a positive response to bronchodilator medication.  The Advair and Singulair were restarted and the CI was given an additional short acting bronchodilator for use as needed.  

At a follow-up allergy and asthma examination on 21 October 2004, the CI reported taking his medications.  PFT showed FEV-1 of 83% with a large positive response to bronchodilator medication.  The Advair dose was increased.  

During another follow-up allergy and asthma examination on 26 October 2004, the CI reported marked improvement on the higher dose of Advair.  Other medications included Singulair.  His PFT was improved since the prior visit.    

A letter from one of the CI’s asthma physicians dated 5 November 2004 indicated the CI had been given samples of Advair in the past.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602 (asthma), citing “medical records do not substantiate compliance with prescribed multiple medications.  Soldier testified under oath he intermittently took asthma medication for extended periods of time while on TDRL.”  The VA rated the asthma condition 10%, coded 6602, based on the STR, citing FEV-1/FVC of 76 percent of predicted.  

Panel members noted the examinations in evidence reported current prescription and use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, as noted by multiple examiners.  Members also noted that although the CI reported a lapse in use of his medication during TDRL, he was also on medication the majority of the time and one of his physicians confirmed he received samples of Advair to use as a courtesy.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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.  Although the CI reported five visits to the emergency room from November 2003 to April 2004, there was no documentation in the STR showing that he received oral steroids at those visits.  At the allergy and asthma examination in October 2004, the CI reported having had emergency room visits, but denied he was given steroids routinely for flare-ups except at his initial diagnosis.  There was 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 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, 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:  

[AR NUMBER], 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.  Inquiries 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.

Enclosure