RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03316
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Health Care Specialist, medically separated for “asthma”  with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20090116	VARD - 20110916	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20101103	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with reactive airways on 17 September 2007 after having difficulty breathing.  She was sent for pulmonary function testing (PFT) and placed on albuterol.  At a follow-up appointment she was diagnosed with asthma.  At the 25 June 2008 pulmonology clinic appointment the CI reported taking albuterol and Singulair.  The examiner noted she had diagnostic PFTs that showed moderate persistent asthma.  She was unable to pass her physical fitness test.  

During the 29 July 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported shortness of breath, problems with wheezing and listed medications of Advair, Singular and albuterol.  On 13 August 2008 (9 months prior to separation), PFTs showed an FEV-1 of 93% of predicted and an FEV-1/FVC of 80%. 

At the 27 September 2008 MEB NARSUM examination, 7 months prior to separation, the CI reported shortness of breath with running and when attempting to carry her medical gear in hot environments.  Physical examination showed regular and unlabored respirations.  Lungs were clear to auscultation bilaterally.  Medications listed were Singulair, albuterol and Advair.  A pulmonary consult dated 15 October 2010 revealed a normal spirometry.  The examiner stated “not clearly improved with combination inhaled bronchodilators (Albuterol and Ipratropium) on this study with normal lung volume, normal transfer of carbon monoxide and normal oxygen tension.

At the 3 November 2010 VA Compensation and Pension (C&P) evaluation, 18 months after separation, the CI reported with exercise she became short of breath and had a burning type pain in her chest.  She reported three or more acute attacks per week, but was not currently treated and that she ran out of medications.  If she had a flare-up she would just rest until improved.    Pulmonary examination findings showed no evidence of abnormal breath sounds.  The examiner stated there was no objective findings and no current treatment records to indicate a diagnosis of asthma.  He referred to the 15 October pulmonary consult above.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing intermittent use of medication.  The VA rated the asthma condition 10%, coded 6602, based on the C&P examination 18 months after separation, citing intermittent use of inhalational bronchodilators (albuterol and Ipratropium).    

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.”  Advair (inhaled anti-inflammatory) was refilled, as noted on the MEB examination.  The September NARSUM examination noted she was taking Advair and Singulair (another bronchodilator.)  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 and bronchodilator 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. 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 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 that 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008821, 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