, XXXXXXXXXX

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Dear XXXXXXXXXX:

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03483
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070613

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 from the Temporary Disability Retired List (TDRL) for “asthma” and “intermittent right shoulder pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  No specific contention made.  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 FPEB - 20070502	VARD – 20060606 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Exercise Induced Asthma	6602	10%	20060518	
Intermittent Right Shoulder Pain	5099-5003	0%	Residuals, Right Shoulder Acromioplasty and Distal Clavicle Resection	5203	10%	20060518	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in 2000 with exercise.  He was treated with Singulair tablets and an albuterol inhaler.  The CI was separated and placed on TDRL in May 2005 with a disability of 30%.  

At the 18 May 2006 VA Compensation and Pension (C&P) examination, 13 months before TDRL removal, the CI reported asthma symptoms: cough, wheezing, and dyspnea.  Belching also could cause an exacerbation of his asthma.  Physical examination showed a normal chest.  Pulmonary function tests (PFT) showed FEVI 73.1% and FEV1/FVC at 77%.  The 24 January 2007 pulmonary medicine examination, 5 months prior to TDRL removal, noted complaints of dyspnea at rest 1 to 2 times per week and exertional asthma symptoms.  Nocturnal symptoms occurred 4 times per month.  Physical examination showed the chest was not overinflated and clear to auscultation.  Respiratory rhythm, movement, and depth were normal.  PFTs showed FEV1 was 83% and FEV1/FVC 75%.  Medications included Singulair (oral bronchodilator) daily with a recommendation for a Flovent inhaler (anti-inflammatory) twice per day, and albuterol inhaler as needed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing FEV1 at 83% after inhaled bronchodilator or intermittent inhalation bronchodilator therapy and noting the medication profile did not provide a sufficient controller needed for daily therapy.  The VA also rated the exercised induced asthma condition 10%, coded 6602, based on the C&P examination, citing FEV-1 of 72.1% predicted value and FEV-1/FVC of 77 percent of predicted value with intermittent inhalation therapy.  

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 panel noted the pulmonary medicine examination reported the requirement for asthma medications which included an oral bronchodilator and an anti-inhalational anti-inflammatory twice per day, and an albuterol inhaler.  For rating under code 6602, the 30% criteria does not require daily use of inhaled anti-inflammatories, and the rating criteria is met with use of inhaled anti-inflammatories at least intermittently.  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.  

Intermittent Right Shoulder Pain (dominant).  According to the STR and MEB NARSUM, the CI’s right shoulder condition began in May 2003 after a 3-year history of right shoulder pain that was not relieved with non-operative treatment.  The CI was placed on TDRL with a disability rating of 10%.  

At the C&P evaluation the CI reported continued problems that were progressively worsening despite surgery.  Physical examination showed a well healed shoulder with no tenderness or inflammation.  Range of motion (ROM) showed flexion to 165 degrees (normal 180) with pain beginning at 165, and abduction at 160 degrees (normal 180) with pain beginning at 160 degrees.  

The 26 January 2007 TDRL examination, 5 months prior to TDRL removal, noted complaints of pain despite operative arthroscopy with sub acromial decompression and distal clavicle excision.  The CI was unable to perform any activity requiring him to lift his arm past 90 degrees or carry any objects or backpack off the right shoulder.  Physical examination showed forward flexion to 90 degrees, and abduction to 90 degrees.  During passive ROM the CI demonstrated significant pain when the shoulder was abducted or forward flexed greater than 90 degrees.  Rotator cuff strength demonstrated 4/5 external rotation with the right shoulder.  Abduction of the right shoulder for evaluation of his deltoid was slightly decreased in strength compared to the left shoulder.  Neurovascular was intact.  No instability was present.  There was pain with all maneuvers.  The May 2007 ambulatory care follow up visit noted the CI had a right shoulder bony protrusion with raising or lowering the shoulder, noting a history of right shoulder partial resection of the right collar bone.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis).  The VA rated the residual, right shoulder acromioplasty and distal clavicle resection condition 10%, coded 5203 (clavicle or scapula, impairment of), based on the C&P examination, citing objective evidence of painful and limited motion.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the NARSUM TDRL examination in evidence demonstrated motion at this level.  The CI was unable to actively raise his arm above this level.  The physical examination documented flexion and abduction of 90 degrees respectively.  The panel majority concluded the findings were consistent with a 20% disability under 5201.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right shoulder condition, coded 5201.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the right shoulder condition, the panel majority recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71.  The single voter for dissent recommends modification to 10% coded 5099-5003 IAW VASRD §4.71, and did not elect to submit a minority opinion.  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%	
Intermittent Right Shoulder Pain	5201	20%	
COMBINED	40%