RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03434
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “asthma” and “right hip pain,” rated 10% each, with a combined  disability rating of 20%.  

CI CONTENTION:  “Original rating does not reflect percentage of actual disability at time of separation and currently.”  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 - 20080813	VARD - 20090206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Upper Airways Resistance Syndrome 	6899-6847	50%	20090108	
Right Hip Pain	5099-5003	10%	Tendinitis, Right Hip	5024	10%	20090108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma began about August 2007 after a long run.  She developed shortness of breath (SOB) on exertion.  Chest X-rays and pulmonary function tests (PFT) were normal and she did not smoke.  Physical examination was unremarkable.  The methacholine test was markedly positive, establishing a diagnosis of asthma.  She was treated with Singular (oral bronchodilator), Advair (inhalational anti-inflammatory) and albuterol (inhaled bronchodilator).  
The 16 May 2008 MEB NARSUM examination, 6 months prior to separation, noted current medication use of Spiriva (inhalational bronchodilator), Singulair, Advair and albuterol.  The 21 May 2008 PFT showed FEV1 of 92% and FEV1/FVC ratio of 87%.  Physical examination showed normal cardiopulmonary examination.  The remainder of the examination was normal.  

At the 8 January 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported SOB on exertion (e.g. lifting more than 15 pounds or walking more than two blocks).  She was taking Advair, Spiriva, Singulair and Xopenex (inhalational bronchodilator).  She was 28 weeks pregnant, carried Xopenex and used it every other day.  She used a CPAP at night due to “restrictive disease” but had no sleep apnea.  PFTs showed FEV1 of 80%.  Physical examination showed normal cardiopulmonary function.   

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 no evidence of daily controller medications, rated for intermittent use of inhalers.  The VA rated the asthma as upper airway resistance syndrome at 50%, analogously coded 6899-6847 (sleep apnea syndromes), based on the STR and C&P examinations, citing the use of a breathing assistance device, such as CPAP.  Panel members considered that the MEB NARSUM and C&P examinations reported current prescription and use of daily inhalational anti-inflammatory agents.  This was confirmed by medication profile, with a fill date of 14 August 2008 and expiration date of 1 January 2009.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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.  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.  

Right Hip Pain.  According to the STR and MEB NARSUM, the CI’s right hip condition began in September 2006 after falling from a vehicle during basic training.  X-rays showed a questionable stress fracture to the right inferior pubic ramus.  She received conservative treatment and there were no further problems until a fall on ice during advanced training in January 2007.  Repeat X-rays showed chronic stress changes to the right inferior pubic ramus but no acute injuries.  She developed severe chronic hip pain after a road march.  A May 2007 bone scan showed no increased uptake in the pelvis, but mild increased uptake in bilateral femurs consistent with “quad splints.”  

During the 25 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, physical examination revealed mild tenderness over the right groin as well as the right buttock.  There was mild pain with loading and range of motion (ROM).  Measurements were flexion of 110 degrees (normal 125) and extension of 15 degrees (normal 20).  The 23 April 2008 MEB NARSUM examination, 6 months prior to separation, noted the hip pain worsened with standing over 10-15 minutes, running or road marching.  Physical examination referenced the 25 March 2008 findings.  

At the 8 January 2009 C&P evaluation, 2 months after separation, the CI reported daily pain in the posterior right hip, which occurred three times per day.  Pain could be elicited by physical activity, but at the time of pain, she could still function.  Physical examination showed posture and gait within normal limits.  There was no sign of swelling, effusion, weakness, tenderness subluxation or guarding of movement.  Flexion was 86 degrees and extension was 10 degrees.  Pain had the major functional impact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing limitation of motion of one major joint.  The VA rated the right hip condition 10%, coded 5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint.  

The panel determined that the CI’s right hip was essentially non-compensable based on the VASRD §4.71a codes for loss of hip or thigh motion (5250 through 5253).  However, according to VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Imaging showed evidence of a healed right pelvic stress fracture and the right hip pain was recurring and limiting.  There was insufficient evidence of a significantly disabling hip condition to justify a rating greater than 10%.  After due deliberation, considering all of 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 right hip condition.  

BOARD FINDINGS:  In the matter of the asthma, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the right hip pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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%	
Right Hip Pain	5099-5003	10%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008985, 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 40% 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