RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04140
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated 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’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 – 20061204	VARD – 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Moderate Persistent Asthma	6602	30%	2007809	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first diagnosed with exercise-induced bronchospasm (a variant of asthma) in 2002 after experiencing shortness of breath and chest tightness while running.  She was prescribed albuterol, which controlled her symptoms.  In July 2005, her symptoms were becoming more frequent, Flovent, an inhaled steroid, was added to her medication regimen, which had little effect, and a month later, she was prescribed Advair, an inhaled steroid and long-acting bronchodilator combination.  The CI reported she only used the Advair two or three times before she discontinued it because she experienced tingling in her fingers with use.  Because the diagnosis was unsure, the CI underwent a cardiopulmonary exercise test on 4 Mar 2006 which showed an 18% decrease in FEV1 (forced expiratory volume in the first second) on spirometry after 15 minutes of exercise, consistent with exercise-induced bronchospasm.  She also underwent laryngoscopy, which showed normal vocal cord function before and after exercise.  

At the 27 July 2006 pulmonary clinic visit, the CI reported the only medication she was using for asthma was albuterol prior to exercise; however, she reported she was using it at least twice daily.  Physical examination showed a normal lung examination without wheezing.  The pulmonologist prescribed Advair and recommended she continue Singulair (considered an oral bronchodilator by the VA).  During the August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported wheezing, shortness of breath and chest pain and listed Advair, albuterol and fluticasone as current medications.  Physical examination demonstrated a normal lung evaluation without wheezing.  On 30 November 2006, pulmonary function testing (PFT) for the MEB after an inhaled bronchodilator showed FEV-1 87% of predicted and an FEV-1/FVC of 82%.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  

A medication profile from Fort Hood printed on 4 December 2006 found the CI received a single 17 gm albuterol inhaler on 26 May 2005 without refills and there were no other prescriptions at Fort Hood for that medication.  She also received a 3-month supply of Flovent on 12 July 2005 with refills for 1 year; however, none of the refills was ever processed.  An additional medication profile from Fort Sam Houston, where the CI received her pulmonary evaluations, printed on 5 December 2006 showed a prescription for a single (one month supply) Advair Diskus on 2 August 2005 which was not refilled and another single Advair dispensed 16 October 2006, again without being refilled.  The same medication profile showed a single 17 gm albuterol inhaler was dispensed 2 August 2005 and was never refilled and a 90-day supply of Singulair was dispensed 28 June 2006 and never refilled.  

At the 9 August 2007 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported since separation she was only using an albuterol inhaler and Flonase for nasal congestion.  The CI reported she developed chest tightness as well as difficulty breathing with more than minimal effort, but it also occurred at rest.  She reported she was using the albuterol at least 4 times per day.  PFT performed on 17 August 2007 showed FEV-1 88% of predicted and an FEV-1/FVC of 72%.  The CI stated she felt short of breath and gave less effort on the post-bronchodilator test.  Physical examination noted lungs were clear to percussion and auscultation.

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 intermittent inhaler.  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing “your report of needing your albuterol inhaler four times per day.”  

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.  While the medication profiles called into question the claim of daily inhalational bronchodilators, 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  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	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006256, 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), XXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure