RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04583
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Health Care Specialist, medically separated for “asthma” with a disability rating of 10%.   

CI CONTENTION:  The asthma condition has not resolved and symptoms persist.  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 FPEB - 20060417	VARD - 20060821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma 	6602	10%	Asthma	6602	30%	20060804	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with asthma in 2002 and subsequently had a several year history of exertional dyspnea, wheezing and frequent episodes of bronchitis with productive cough.  Despite using an albuterol (inhaled bronchodilator), Advair (inhaled anti-inflammatory) and montelukast (oral bronchodilator), he continued to have exertional dyspnea and wheezing.  A chest X-ray on 13 June 2005 showed mild central bronchial thickening, but was otherwise normal.  

The 15 February 2006 MEB NARSUM examination, 5 months prior to separation, noted the CI was taking fluticasone (inhaled anti-inflammatory), salmeterol (inhaled bronchodilator), montelukast and albuterol.  Physical examination showed normal chest inspection and percussion, with clear lungs bilaterally, and no focal wheezing, rhonchi or signs of consolidation.  Pulmonary function tests (PFT) showed FEV1 at 98% predicated and FEV1/FVC ratio at 79%, post-bronchodilator therapy.  A subsequent PFT on 6 August 2006, 1 month after separation, showed FEV1 at 113% and FEV1/FVC ratio at 104%.

At the 21 August 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported shortness of breath with walking secondary to wheezing.  Medications included Advair, Singulair (oral bronchodilator) and albuterol.  Physical examination showed no wheezes, rales or rhonchi on inspiration or expiration. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma), citing intermittent inhalation therapy.  The VA rated the asthma 30%, coded 6602, based on the C&P examination, citing a requirement for daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  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 NARSUM and VA examinations reported current prescription and use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision.  Thus, members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case.  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 condition, 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%	

The following documentary evidence was considered:

AR20190005372, 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), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557.
A copy of this decision has also been provided to the Department of Veterans Affairs.