RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05559
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “asthma” with a disability rating of 10%.   

CI CONTENTION:  “….asthma is a permanent and daily disability…requires oral steroids (inhalation)…”  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 - 20050217	VARD - 20050411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20050308	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma symptoms began in 2004 with shortness of breath (SOB) when exposed to cold air and during strenuous exercise.  In August 2004, baseline spirometry showed an FEV-1 ratio of 110% which was interpreted as normal.  However, a methacholine challenge test revealed a 20% decrease in FEV-1 with a methacholine dose of 2.5 mg/ml.  At the 12 January 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported wheezing and SOB with cold air and severe exertion, and the inability to wear a gas mask.  Physical examination revealed clear lungs without wheezes, rhonchi or other abnormal sounds; medications included Advair (inhalational steroid/bronchodilator combination).  

At the 8 March 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported a productive cough with sputum or blood, SOB and painful breathing.  Exacerbations of asthmatic symptoms occurred weekly, and the CI endorsed the continued requirement for inhalation of anti-inflammatory and bronchodilator medication.  The respiratory examination revealed normal and non-labored breath sounds.  A pulmonary function test performed on 7 March 2005 showed normal parameters of FEV-1 of 95% and FEV-1/FVC of 84%.  The examiner did not render a diagnosis of asthma but rather documented the following:  “There is no diagnosis because there is no pathology to render a diagnosis. [The CI] does not have any complications secondary to his pulmonary disease.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma), citing clear lungs on examination and that the CI was non-compliant with medical management.  The VA rated the asthma 30%, coded 6602, based on the historical diagnosis of asthma via a positive methacholine challenge test and use of inhaled corticosteroids as evidenced in the STR.  In its deliberations, panel members considered the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory therapy was met, as it is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97.  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  The panel noted that the examinations in evidence reported current prescription and use of daily bronchodilators and inhaled anti-inflammatories, and agreed that the threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication use.  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, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.07.  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%	

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 permanent 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), 
	A copy of this decision has also been provided to the Department of Veterans Affairs.