XRECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX	CASE: PD-2018-00118
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040420

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

CI CONTENTION: Review of all conditions requested. 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 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 - 20040206	VARD - 20040421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Persistent Asthma…	6602	10%	Asthma	6602	30%	20030424	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 90%	

ANALYSIS SUMMARY:

Mild Persistent Asthma. According to the service treatment record (STR) and Medical MEB narrative summary (NARSUM), the CI’s asthma condition began as early as April 2001 with a history of recurrent exertional shortness of breath. A diagnosis of asthma was made based on clinical presentation and pulmonary function testing (PFT) with positive Methacholine challenge.

At the 24 April 2003 VA Compensation and Pension (C&P) evaluation, 12 months prior to separation, the examiner noted that the CI was taking daily doses of Proventil (albuterol), Singulair (an oral indirect-acting bronchodilator), and Advair. PFTs showed an FEV-1 of 115% of predicted and an FEV-1/FVC of 89%. Chest X-ray and physical examination of the lungs were normal. According to the flight medicine clinic evaluation on 9 June 2003, the examiner noted that the CI was “currently managed on albuterol (an inhalational bronchodilator), Advair (inhalational anti-inflammatory/bronchodilator combination), and Serevent (salmeterol, an inhalational bronchodilator).”

The 24 September 2003 MEB NARSUM examination, 7 months prior to separation, noted the CI had in the past been taking Singulair, Advair, and albuterol, “although it seems she has not been on any medicines for quite some time.” Physical examination of the lungs was normal. During

the next-day MEB examination (recorded on DD Form 2807-1) the CI reported taking albuterol and Singulair. At the 16 March 2004 flight medicine clinic, one month prior to separation, the CI was noted to be taking Singulair. The examiner indicated she should continue taking Singulair, and added a prescription for Flovent (fluticasone, an inhalational anti-inflammatory). 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. There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the asthma condition at 10%, coded 6602 (asthma, bronchial). The VA used the same code, but rated the asthma condition at 30%, citing “use of Singulair (one tablet every day) and Albuterol (on an as needed basis).”

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.” While there was some contradictory evidence regarding consistency of medication usage, panel members considered that the examinations in evidence reported a current prescription of at least one daily oral bronchodilator (specifically Singulair) as well as a prescription for an inhaled anti-inflammatory (Flovent) as noted by the flight medicine examiner most proximate to separation. Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and 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. 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 mild persistent asthma, 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	
Mild Persistent Asthma…	6602	30%	

The following documentary evidence was considered:
2	PD-2018-00118

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO
6040
CORB:003 14 May 21

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXXX

Subj:	Physical Disability Board of Review Determination Ref:	(a) 6040.44(Series)
1.	The Physical Disability Board of Review (PBDR) reviewed your case in accordance with reference
(a) and forwarded their recommendation for action.

2.	On 23 April 2021 the Assistant Secretary of the Navy (Manpower and Reserve Affairs) accepted the PDBR’s recommendation of an increase in disability rating to 30% and placement on the Permanent Disability Retired List. This decision was then sent to Navy Personnel Command for appropriate action.

3.	The PDBR determination is final and not subject to appeal or review.