RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05605
BRANCH OF SERVICE:  army	SEPARATION DATE:  20081201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “asthma” with a disability rating of 10%.

CI CONTENTION:  Continued issues with any kind of physical activity.  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 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 Physical Evaluation Board (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 - 20080828	VARD - 20090518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20081112	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was initially treated for shortness of breath in November 2005 with a working diagnosis of extrinsic asthma.  He was prescribed several asthma medications, but during an allergy clinic visit on 21 May 2008, he stated that he had been off the prescriptions for months because “they seemed completely ineffective.”  The provider noted that the CI “is certainly no better, but is not worse off meds.”  No medications were prescribed at this visit. 

During the 23 July 2008 MEB NARSUM, 4 months prior to separation, the CI reported using albuterol (inhalational bronchodilator) “6 to 7 puffs per day,” and Combivent (inhalational bronchodilator) “once a day in the mornings.”  He had stopped utilizing Singular (oral bronchodilator) and Advair (inhalational anti-inflammatory) in March 2008.  The physical examination (PE) was unremarkable, and current asthma medications included Combivent and albuterol.  A pulmonary function test (PFT) was performed 2 weeks after the NARSUM on 8 August 2008, and revealed an FEV-1 of 91% predicted and FEV-1/FVC of 101%. 

At the 12 November 2008 VA Compensation and Pension (C&P) examination, 3 weeks prior to separation, the CI reported continued asthma-like symptoms with exertion, but that he was not receiving any treatment for the same.  Asthma medication was recorded as “none,” and respiratory examination was normal.  Another PFT was performed on 17 November 2008, and showed normal resting respiratory function.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma, bronchial), citing albuterol and Combivent use on an intermittent basis.  Utilizing the same code, the VA rated the asthma condition 0%, based on the VA examination, citing a non-compensable criteria. Panel members noted that a 30% rating under code 6602 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 panel deliberated and agreed that the VA examination documenting “none” for medication use, coupled with the CI’s previously self-endorsed discontinuance of oral bronchodilator and inhaled anti-inflammatory medications, nullified support for a 30% rating.  Additionally, there were no PFT results proximate to separation to support a 30% rating.  A higher 60% rating was not justified in the absence of monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.  There was a significant drop in the use of an inhaled bronchodilator from 6-7 times a day to no medication use at 3 weeks prior to separation, and thus, such evidence would rate no greater than 0% under the medication criteria of 6602.  However, IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the asthma.

BOARD FINDINGS:  In the matter of the asthma and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

PD-2017-05605

XXXXXXXXXXXXXXX

Dear XXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

PD-2017-05605