XXXXXXXXXXXXXXXX. 

Dear  XXXXXX:

Accept Denial
	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.
 
	A copy of this decision has been provided to the counsel you listed on your application;

Accept Retirement
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 10% effective the date of your medical separation for disability with  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, 
	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].

Accept Modification
The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 10% but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application; [name and address].

Accept TDRL – No Change
	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at ZZ% disability for six months effective the date of your original medical separation for disability with [severance pay] [Reserve retirement] and then following this six month period no re-characterization of your separation or modification of the permanent disability rating of 10%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period will result in an adjustment to your pay providing you ZZ% retired pay for six months from the date of your original medical separation and then no re-characterization of your separation or modification of the permanent disability rating of 10% following the constructive six month TDRL period. 

	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.  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 [and to the counsel you listed on your application; [name and address]].

Accept TDRL - Modification
	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at ZZ% disability for six months effective the date of your original medical separation for disability with [severance pay] [Reserve retirement] and then following this six month period your disability rating should be modified to 10%  but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  

The constructive TDRL period will result in an adjustment to your pay providing you ZZ% retired pay for six months from the date of your original medical separation. This will not result in any change to the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	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.  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, 
	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxx	CASE:  PD-2017-05722
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051001

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

CI CONTENTION:  No specific contention was made.  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 - 20050829	VARD - 20060629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Exercise Induced	6602	10%	Asthma, with Upper Airway Obstruction and Pulmonary Hypertension	6817-6602	30%	20060223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Exercise Induced Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma symptoms began in November 2004 during a 15-mile road march in basic training.  She reported a cough and wheeze upon aerobic exertion, and pulmonary tests and an echocardiogram revealed mild pulmonary hypertension.  She had a normal exercise stress test, but a positive methacholine challenge test was assessed to be consistent with mild bronchial hyperactivity.  A pulmonary function test (PFT) conducted on 10 March 2005, 7 months prior to separation, showed an FEV-1 of 89% of predicted and an FEV-1/FVC of 83%.  On 22 April 2005, a pulmonologist documented mild intermittent asthma and the need for albuterol (inhalational bronchodilator) prior to physical training.  At a primary care visit on 28 April 2005, the provider noted albuterol as needed “before exercise.”  

During the 3 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported she had been diagnosed with asthma and pulmonary hypertension.  Physical examination revealed normal lungs and the examiner documented albuterol as needed.  The MEB NARSUM examination the same day, noted complaints of “difficulty breathing with running,” and the inability to run for long distances at an acceptable pace due to shortness of breath (SOB).  The examiner noted that the asthma was well-controlled with albuterol as needed, and that the CI did not require daily bronchodilator treatment, anti-inflammatory medication or steroids.  Physical examination showed clear lungs bilaterally, with equal breath sounds, and no wheezes, rubs or rhonchi.

At the 23 February 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported no follow-up visits since leaving the service, but that she continued to experience SOB on exertion, and took albuterol 3 times a day "as needed” for symptoms.  Physical examination showed her to be in no apparent distress with clear lungs.  The examiner documented that although the CI reported good response with albuterol 3 times a day, she was “still limited in what she can do.”  During the 20 March 2006 VA C&P pulmonary examination, 6 months after separation, the CI reported that since leaving the service, she had a cough on most days, SOB while climbing stairs, and two asthma attacks since October 2005, which did not require emergency room visits.  She stated that she used albuterol 3 times a day “on a regular basis,” and had a recent course of oral steroids (not in evidence).  A PFT showed FEV1 of 91% predicted, and FEV1/FVC of 100% predicted.

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 as needed with fair control of her symptoms.  The VA rated the asthma 30%, dual coded 6817-6602 (pulmonary vascular disease-asthma, bronchial), based on the C&P examination, citing daily inhalational therapy.  At the time of separation, the STR documented only intermittent use of an inhaled bronchodilator before physical training, with good response, and FEV1 and FEV-1/FVC consistent with non-compensable rating.  Members noted that that the C&P examinations provided conflicting statements regarding the pattern of medication use, and therefore placed higher probative value on the STR and MEB examinations which were more proximate to separation and offered more consistency in reporting of the CI’s condition and medication requirement.  Thus, the panel agreed that a 10% rating, but no higher, was justified for intermittent inhalational bronchodilator use.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the exercise induced asthma.  

BOARD FINDINGS: In the matter of the exercise induced 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.