RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03570
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070606

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” with a disability rating of 10%. 

CI CONTENTION:  No specific contention was 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 PEB – UNK	VARD - 20080303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma 	6602	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma began in the spring of 2004 after developing episodes of shortness of breath, wheezing and a nonproductive cough.  After a positive methacholine challenge test, she was started on albuterol MDI (multi-dose inhalational bronchodilator), Singulair (oral indirect bronchodilator), and Advair (anti-inflammatory steroid/bronchodilator combination) with a fair response.  The CI was separated and placed on the TDRL on 18 August 2005.

The first available treatment note while the CI was on the TDRL was the 19 May 2006 VA clinic visit where she was seen for lab results and medication review.  She reported compliance with the albuterol MDI, but said she experienced “gagging” as a side effect of the medication; she denied any hospitalizations.  At a 5 July 2006 VA clinic appointment, the CI indicated she was pursuing employment and needed documents completed for the physical examination.  Noted medications included albuterol and Advair.  Physical examination revealed positive forced exhalation wheezing in the lungs bilaterally, and the examiner assessed 
“asthma controlled with a bronchodilator/steroid inhaler.”  The CI returned on 1 November 2006 for completion of the fitness ability forms in support of her employment application.  She denied any respiratory symptoms and interval exacerbations, and the provider stated she had no fitness limitations or active disease processes, and was able to participate in timed calisthenics to qualify for her perspective job.  She was tasked to follow-up in one year. 

The CI was next seen on 17 March 2007, 3 months prior to TDRL removal, by a civilian provider for an albuterol refill.  The progress note indicated she was also requesting a statement that she had asthma and took medication.  Examination revealed expiratory wheezes and the provider assessed “1) sinus and 2) asthma.”  The treatment action plan included Allegra (antihistamine) for the sinus condition; and Advair, albuterol as needed, and prednisone (20mg twice a day for 5 days and then 20mg once a day for 5 days) were prescribed for the asthma.  

The CI presented again on 16 April 2007 to the VA clinic, 2 months before TDRL removal, and requested current PFTs (pulmonary function tests) to support her disability claim.  She reported she was using her inhaler and had exacerbations related to weather.  On 21 April 2007, PFTs indicated a normal forced vital capacity (FVC), but decreased forced expiratory volume at 1 second (FEV-1) and FEV-1/FVC (no quantitative measurements).  Diffusing capacity of carbon monoxide (DLCO) was normal, and the findings were determined to represent a moderate obstructive defect.  Maximum voluntary ventilation was decreased suggesting a poor effort or neuromuscular disease, but the examiner noted a significant response to inhaled bronchodilator. 

There was no VA examination proximate to separation in evidence.  The 3 March 2008 VA Rating Decision referenced the April 2007 PFTs, which revealed a moderate obstructive defect, and outpatient treatment records, which noted prescribed oral bronchodilator therapy. 

The next and last note treatment note in evidence was dated 16 May 2008, 11 months after TDRL removal.  The CI presented for medication refill of albuterol and Claritin (an antihistamine), and reported using her albuterol inhaler 3-4 times a week.  The examiner’s assessment was mild, persistent asthma, and Asmanex (steroid, inhalational anti-inflammatory drug) was prescribed. Additionally, prednisone as needed was renewed and the CI was advised to quit smoking.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%.  The VA rated the asthma 10%, coded 6602 (bronchial asthma), based on the STRs from 22 November 2003-21 June 2005 and VA treatment records from 25 January 2006-25 April 2007, citing “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator 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 majority note that inhaled anti-inflammatories were prescribed 3 months prior to TDRL removal and thus agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case.  There no PFT findings to alternatively support a 30% rating, and 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.  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, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma, the panel majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent recommends no change 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%	

AR20190010715, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 permanent 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.