RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03441
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050505

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

CI CONTENTION:  “Most of my elements when I separated were not rated.  Like my depression and back pain.”  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 - 20050118	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracic Back Pain	5237	10%	No VA Rating Decision in Evidence	
Asthma	6602	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Thoracic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in April 2002 after hitting her back on the tailgate of a truck.  Radiographic studies showed scoliosis.  Conservative treatment was unsuccessful and the CI was not a candidate for surgery.  

The 24 May 2004 MEB NARSUM examination, 11 months prior to separation, noted complaints of back pain.  Physical examination showed tenderness.  The CI was able to heel, toe, and duck walk without a problem.  There was no sciatic notch tenderness.  The 13 July 2004 MEB NARSUM examination, 10 months prior to separation, noted complaints of upper back pain.  Physical examination showed a normal gait and no spasm, but there was tenderness.  The range of motion (ROM) evaluation was normal. 

At the 10 February 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported pain in the middle portion of her back.  On physical examination there was no tenderness, muscle spasm or radiating pain on movement.  The thoracolumbar (TL) ROM study showed flexion of 90 degrees (normal) and combined ROM of 240 degrees (normal). The ROM was not limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  The VA examiner noted no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  Thoracic spine X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral or cervical strain), citing tenderness and full ROM.  There was no VA rating decision in evidence.  

The panel agreed that no higher than a 0% rating was justified for the back condition at separation.  At the C&P examination, the most proximate examination to separation, TL ROM was full and there was no evidence of tenderness or muscle spasm.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.    

Asthma.  According to the STR and MEB NARSUM, the CI’s asthma condition began in 2002 while deployed.  Baseline spirometry in July 2004 showed an FEV-1 of 78% predicted and an FEV-1/FVC of 84%.  A pulmonary consult on 31 August 2004, 8 months prior to separation, indicated a methacholine challenge test was positive consistent with a diagnosis of asthma.  

The 24 May 2004 MEB NARSUM examination which was signed on 27 September 2004, 7 months prior to separation, noted complaints of shortness of breath, wheezing and chest tightness.  The examiner noted that pulmonary had changed the CI’s medications from a steroid inhaler (Flovent) and a bronchodilator inhaler (albuterol) to an anti-inflammatory inhalational medication (Advair) and an oral bronchodilator (Singulair).  

During the C&P examination, 3 months before separation, the CI complained of shortness of breath and asthma attacks four times per year.  The CI reported daily use of inhalational anti-inflammatory medication and daily use of inhaled and oral bronchodilator medications.  Spirometry was normal, with no significant response to bronchodilator medication.  Chest X-ray was normal.  

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 pulmonary function testing which showed and FEV1 of 78% predicted and FVC of 79% predicted.  

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.”  Inhaled anti-inflammatories were prescribed, as noted by the multiple pulmonary clinic evaluations and the NARSUM noted use of inhaled anti-inflammatory and oral bronchodilator medications daily.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or inhalational anti-inflammatory medication use. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the back condition, coded 5237, and a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 0%, coded 5237 IAW VASRD §4.71a.  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	
Chronic Thoracic Back Pain 	5237	0%	
Asthma	6602	30%	
COMBINED	30%	

AR20180015376, 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.