RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05183
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Chemical Operations 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’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 - 20060228	VARD - 20050509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Exercise Induced Asthma	6602	30%	20050311	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented with exertional chest pain and shortness of breath in spring 2002.  Exercise induced asthma was diagnosed in August 2002 and the CI was placed on TDRL on 26 August 2003. 

During the first TDRL re-evaluation on 26 August 2004, the CI reported taking Advair (inhaled anti-inflammatory) twice daily, albuterol (inhalational bronchodilator) as needed and Singulair (oral bronchodilator) daily.

At the 11 March 2005 VA Compensation and Pension (C&P) examination, 12 months before TDRL removal, the CI reported wheezing and shortness of breath while walking fast especially during the summer.  The CI denied ER visits during the previous year.  Physical examination showed no dyspnea or wheezes.  Current medications included albuterol, as needed, Singulair twice daily and Advair twice daily.  A pulmonary function testing (PFT) showed FEV-1 of 144% predicted and FEV1/FVC of 86% post bronchodilator with good effort and cooperation.

The 20 December 2005 MEB NARSUM examination, 3 months prior to removal from the TDRL, noted complaints of exertional wheezing and awaking at night at least three times per week to use an inhaler (medication not specified).  The CI denied emergency room visits and was not prescribed prednisone the past year.  Physical examination showed a clear chest, good breath sounds and no wheezing.  A PFT showed FEV-1 at 89% predicted and FEV-1/FVC of 100% post bronchodilator.  Asthma medication was not addressed.  

Medication profiles in the STR showed Advair and Singulair being filled on 24 February 2006, 1 month before TDRL removal.  Albuterol was last filled on 29 November 2005.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing insufficient quantity of daily therapy.  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing use of inhalational anti-inflammatory medication.

Under code 6602, 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.”  Inhalational anti-inflammatory medication does not require daily use and the CI was prescribed an inhalational anti-inflammatory (Advair) 1 month before TDRL removal.  

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.  There was no PFT evidence to support the next higher 60% 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 condition at the time of TDRL removal.

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%	

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.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO) 

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