RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04580
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Firefighter, medically separated for “asthma, with normal spirometry,” with a disability rating of 10%.  

CI CONTENTION:  The rating should be increased based on the use of daily asthma medications.  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 - 20070416	VARD - 20070822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Immunoglubin E Mediated Asthma	6602	10%	20070611	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record MEB narrative summary (NARSUM), the CI’s asthma began in July 2006 after participating in hose drills as part of his fire fighter training.  Pulmonary function testing (PFT) on 6 March 2006 showed an FEV-1 of 139% of predicted and an FEV-1/FVC of 89%.  According to the lung clinic evaluation on 28 August 2006, approximately 8 months prior to separation, the CI presented for evaluation of dyspnea.  The examiner noted the CI had exercise-induced hyperinflation, air trapping and significant pulmonary limitation.  The pulmonologist prescribed Singulair (oral bronchodilator) twice a day, QVAR RediHaler (inhaled anti-inflammatory/corticosteroid) twice a day and albuterol (inhalational bronchodilator) as needed.  

At the lung clinic evaluation on 8 September 2006, 8 months prior to separation, the pulmonologist started him on a trial of Advair (inhalational anti-inflammatory) twice a day and continued to prescribe the oral-bronchodilator, Singulair twice a day.  The lung clinic evaluation on 27 October 2006, approximately 6 months prior to separation, the CI presented for asthma, chest pain, and palpitations.  The examiner stated the Holter monitor did not show any significant arrhythmia.  The CI used a QVAR RediHaler twice a day and albuterol as necessary.  Advair was discontinued to eliminate the factor of beta-agonist for palpitations.  

During the 7 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported utilizing a QVAR RediHaler.  PFTs were within normal limits.  The 21 November 2006 MEB NARSUM examination, 5 months prior to separation, noted that the CI was taking QVAR RediHaler twice a day and albuterol.  PFTs from the 14 March 2007 MEB NARSUM examination, 2 months prior to separation, showed an FEV-1 of 103% of predicted and an FEV-1/FVC of 90%.  At the 27 March 2007 lung clinic examination, 1 month prior to separation, the CI was prescribed a QVAR RediHaler.  The off-site pulmonologist stated his office had been giving the CI samples, so it had not been necessary for the CI to fill the prescription from the pharmacy.  

At the 11 June 2007 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported using QVAR RediHaler twice per day and an albuterol inhaler as needed for shortness of breath.  His medications were effective.  The examiner noted the CI’s lungs were clear to auscultation bilaterally and X-rays of the chest were normal.  PFTs showed an FEV-1 of 121% of predicted and an FEV-1/FVC of 87%.  

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 bronchodilator therapy.  The VA also rated the asthma condition 10%, coded 6602, (asthma, bronchial), citing medication for control.  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.  Panel members considered that the examinations in evidence reported a current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed and used, as noted by the pulmonary clinic examinations on 28 August 2006, 8 September 2006 and 27 October 2006, as well as the MEB NARSUM examination on 21 November 2006 and lung clinic examination on 27 March 2007.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170505, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180006670, 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