RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-03869
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050111

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” with a disability rating of 10%.

CI CONTENTION:  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 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 - 20041118	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Asthma. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was admitted for inpatient treatment of asthma symptoms in May 2002, which required a prolonged prednisone (systemic steroid) taper. He was separated and placed on TDRL on 20 July 2003.

At the 6 October 2004 MEB NARSUM examination, 3 months prior to separation, the CI reported that he was currently on the third day of a 5-day course of Prednisone after an emergency room (ER) visit 3 days earlier (treatment entry not in evidence). He was also using albuterol (inhalational bronchodilator) 4-5 times per day. He stated that his prescriptions ran out in October 2003 and since that time, he had 12 ER visits which resulted in 5-day Prednisone treatments each time. The examiner noted a current prescription of “albuterol metered dose inhaler used as needed,” and referred to a physical examination performed on 16 September 2004 which documented normal oxygen saturation on room air. Lungs were notable for diffuse but scant expiratory wheezes, and pulmonary function testing (PFT) showed an FEV-1 of 97% of predicted and an FEV-1/FVC of 72%. The examiner prescribed Advair (inhalational anti- inflammatory)  twice  a  day,  and  albuterol  as  needed.  Review  of  the  STR  found  no  clinical

encounter notes in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation, although the CI reported 12 ER-related steroid burst treatments over the past year (no source ER documents were in evidence for the panel to consider).  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 10%, coded 6602 (asthma). The PEB cited normal spirometry and intermittent inhalational bronchodilator therapy. Remote VA records indicated a 30% rating, coded 6602, effective since 2003 and continued through at least 2007. Panel members noted that a 30% rating, which 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,” was reasonably satisfied in this case as the CI was prescribed Advair for daily use and/or was using daily albuterol. The panel considered the entirety of the record for a possible 60% due to intermittent (at least three per year) courses of systemic corticosteroids, or asthma exacerbations frequent enough to require monthly visits to a physician, which was described by the CI in the NARSUM. However, there were no source ER records available in evidence to confirm the numerous visits reported by the CI. Additionally, later VA records indicated no pre- separation ER records were supplied despite VA requests, and the VA rating was a sustained 30% through the 2007 VARD. There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids or immunosuppressive medication, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%). There was no PFT evidence to support any higher 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, coded 6602.

BOARD FINDINGS: In the matter of the asthma, 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	
Asthma	6602	30%	

PD-2017-03869

AR20200000230, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

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), XXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

PD-2017-03869