RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03504
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tracked Vehicle Mechanic, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  “[W]ith exercise induced asthma I am limited to what I can do without over exerting myself.  Review all conditions.”  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 - 20080229	VARD - 20081217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20080806	
Intermittent Right Ankle Pain	Not-Unfitting	Residual of Right Ankle Sprain	5271	10%	20080806	
Intermittent Left Knee Pain	Not Unfitting	Chondromalacia Paella, Left Knee	5257-5260	10%	20080806	
Intermittent Right Shoulder Pain	Not Unfitting	Impingement and Tendinopathy of the Right Shoulder	5201	10%	20080806	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in October 2006 during a 5-mile run when the CI experienced shortness of breath, chest pain, and left arm tingling and numbness.  Upon completion of the run, the CI was medically evaluated and referred to internal medicine where a treadmill stress test was determined to be abnormal.  A cardiac catheterization that followed was determined to be negative and the CI was started on an Advair inhaler (inhalational anti-inflammatory/bronchodilator combination).  A 7 December 2007 pulmonary function test 7 months prior to separation, showed post-treatment FEV1 of 77% and FEV1/FVC of 86%.  

The 10 January 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of atypical chest pain and SOB with exertion.  Physical examination showed the lungs were clear.  A medication profile dated 16 January 2008 showed Advair and Albuterol (inhalational bronchodilator) as active medications.  At the 3 April 2008 Disease Management examination, 3 months prior to separation, the CI reported using an Advair inhaler twice a day and albuterol up to four times a day.  The provider discussed adding Singulair to decrease rescue inhaler use once live function tests normalized.  The active medication list showed Albuterol inhaler and Advair inhaler as active medications, and the provider prescribed a higher-dose Advair as a short-term trial.  

At the 6 August 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported his asthma was determined to be “exercised induced” and he was controlling his symptoms with albuterol and Advair inhalers.  Physical examination showed a normal pulmonary examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing intermittent inhalation or oral bronchodilator therapy based on medication profile.  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing the 30% rating criteria.  

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.”  To meet the 30% VASRD 6602 criteria for use of “inhalational anti-inflammatory medication” there is no requirement for the CI to use inhaled anti-inflammatory medication daily or that a minimum amount be used on days the CI uses the inhaled anti-inflammatory medication. Panel members considered that the NARSUM, Disease Management, and VA examinations reported a current prescription and use of inhalational anti-inflammatory medication.  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.  There was no PFT evidence to support the next higher 60% rating.  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.  

Contended PEB Conditions:  Intermittent Right Ankle Plan, Intermittent Left Knee Pain, and Intermittent Right Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and they did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

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 contended right ankle, left knee, and right shoulder conditions, the panel recommends no change from the PEB determinations as not unfitting.  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%	

AR20190008542, 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.  Inquiries 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.