RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04801
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Food Service 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 - 20050131	VARD - 20060308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20060207	
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 was evaluated in February 2004 while on an active duty for a recent history of wheezing during activities.  Pulmonary function testing (PFT) in February 2004 showed an FEV-1 of 82% of predicted and an FEV-1/FVC of 84%.  Methacholine challenge testing in May 2004 confirmed the diagnosis of asthma.  During the 28 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported taking albuterol (inhalational bronchodilator) and Advair (inhalational anti-inflammatory) but did not specify frequency for either medication.  The 23 August 2004 MEB NARSUM examination, 5 months prior to separation, noted the CI was taking Advair and albuterol as needed.  A PFT showed FEV-1 of 79% of predicted and FEV-1/FVC of 77%.  A medication profile in the evidence of record showed the CI filled prescriptions for Advair on 26 May 2004, 28 July 2004 and 28 October 2004.  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.  

At the 7 February 2006 VA Compensation and Pension (C&P) general examination, 10 months after separation, the CI reported her asthma was stable, but had increased wheezing with exertion and exposure to smoke or strong smells.  Her symptoms were worse in cold weather.  She used her albuterol inhaler on an as needed basis, reporting she was currently using it once every 1 to 2 months.  There was no mention of use of Advair at the time of the C&P examination.  A PFT showed FEV-1 of 94% of predicted and FEV-1/FVC of 78%.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing FEV-1 of 79% predicted, FVC of 89% predicted and intermittent use of both Advair and albuterol.  The VA also rated the asthma condition 10%, coded 6602, based on the C&P general examination, citing intermittent inhalational 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.”  Panel members considered the examinations in evidence prior to separation which reported current prescription and use of inhaled anti-inflammatories.  Panel members agreed the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication (Advair) 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 or PFT evidence.  Panel members noted at the time of the C&P general examination, 10 months after separation, the CI only reported the use of albuterol, and the VA rated her at 10% based on intermittent bronchodilator use.  However, the evidence of record shows the CI was prescribed and using Advair as documented by the PEB adjudication 2 months prior to separation.  There was no evidence to refute the CI’s Advair use at time of separation.  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 condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.96.  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, 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:

[AR NUMBER], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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, (TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

			      
Enclosure