RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03257
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051205

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

CI CONTENTION:  His rating should be higher and he requested that all conditions be reviewed.  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 - 20051118	VARD – 20050517 & 20060127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Reactive Airway Disease/Exercise Induced Asthma	6602	10%	20051202	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), on 3 November 2004 the PEB found her unfit for asthma and she was placed on the TDRL.  The CI re-located and was followed by a civilian primary care provider.  
The 6 October 2005 MEB NARSUM examination, 2 months prior to TDRL removal and final separation, noted that over the past year the CI’s asthma symptoms “have essentially remained the same.”  She continued to experience shortness of breath with any form of significant exertion and reported taking her albuterol (inhalational bronchodilator) less than once per day.  She stated she could walk approximately one mile on level ground, but had difficulty with stairs or any type of cardiovascular fitness exercise.  Her symptoms were aggravated by hot weather and humid environments.  She was using one puff twice per day of Advair 250/50 (inhalational anti-inflammatory/bronchodilator combination) and albuterol as needed.  Physical examination showed her lungs were clear to auscultation bilaterally.  Same-day pulmonary function testing (PFT) showed an FEV-1 of 71% of predicted and an FEV-1/FVC of 89%.  The spirometry impression was that the CI had a mild restrictive pattern with no evidence of obstructive lung disease.  

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, however the CI was treated by a civilian primary care provider during her TDRL period and clinical documentation may have not been readily available.  The PEB did request and receive the CI’s civilian medication profile which documented prescriptions for Albuterol and Advair that were dispensed on 23 September 2005.  

At the 2 December 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported asthma with flare-ups with wheezing and feeling winded approximately three to four times per week that generally resolved with as-needed albuterol inhaler use, with occasional “bad” episodes.  The CI had two emergency department visits in the past 4vmonths with dyspnea and a coughing spell and one ambulance response not requiring transport.  Medication use was albuterol as needed, generally three to four times per week, Advair one puff twice a day, and Singulair, one puff daily.  Physical examination showed normal lungs and normal spirometry.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both rated the asthma condition 10%, coded 6602.  The PEB cited “FEV1 71%, not requiring daily controller medication.”  The VA citing the VASRD 10% rating criteria, based on the STR and C&P examination.  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 30% criteria for asthma for “inhalational anti-inflammatory medication” does not require daily use.  Panel members considered that the TDRL removal NARSUM examination reported a current prescription and use of an inhaled anti-inflammatory (Advair) that was also supported by a civilian medication profile and C&P examination.  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.  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, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  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:

AR20190010018, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 permanent 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.

		      

Enclosure