RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX 	CASE:  PD-2021-00026
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty  E4, Chaplain Assistant, medically separated for “asthma” with a disability rating of 0%.   

CI CONTENTION:  She requested review of PTSD, right shoulder impingement, right knee chondromalacia, thoracolumbar spine degenerative arthritis, hearing loss, and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20050729	VARD - 20051229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	30%	20041019	
Intermittent Allergic Rhinitis 	Not Unfitting	No VA Placement	
Depression	Not Unfitting	Major Depressive Disorder	9434	10%	20041019	
Retropatellar Pain Syndrome	Not Unfitting	Chondromalacia; Right Knee	5299-5260	0%	20041019	
Chronic Back Pain	Not Unfitting	Degenerative Arthritis, Strain, Thoracolumbar Spine	5237	10%	20041019	
Hearing Loss	Not Unfitting	Bilateral Conductive Hearing Loss	6100	0%	20041019	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in 2002 with intermittent shortness of breath.  Pulmonary function testing (PFT) performed on 25 May 2004 showed FVC was 3.031, 82% predicted, FEV1 was 2.021, 62% predicted with an FVC/FEV1 ratio of 66%.  

At the 19 October 2004 VA Compensation and Pension (C&P) examination, 13 months before separation, the examiner noted that the CI was taking Advair™ (inhalational steroid/bronchodilator combination) discus 500 twice daily, albuterol as needed at least once a week, and 5 mg of prednisone as needed.  The CI was prescribed only one treatment with prednisone in August 2004.

On 18 January 2005 PFTs revealed an FVC of 3.191, 87% predicted, and FEV1 2.311, 72% predicted.  She had a 14% increase after bronchodilator therapy.  The 04 April 2005 MEB NARSUM examination, 7 months prior to separation, noted that the CI was taking Advair, one puff two times per day, albuterol inhaler two puffs up to four times a day as needed, and montelukast 10 mg once a day in the evening.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602 (asthma), citing that pharmacy records revealed no use of asthma medications on a daily basis.  Using the same code, the VA rated the asthma condition 30%, based on the C&P examination, citing the use of Advair twice a day.  

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.”  Panel members considered that the examinations in evidence reported a current prescription and use of inhaled anti-inflammatories.  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, coded 6602.    

Contended PEB Conditions:  Depression, Intermittent Seasonal Allergic Rhinitis, Retropatellar Pain Syndrome, Chronic Back Pain, and Hearing Loss.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The back was the only condition implicated in the commander’s statement, however none of the conditions were profiled, and none failed retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended depression, intermittent seasonal allergic rhinitis, retropatellar pain syndrome, chronic back pain, and hearing loss, the panel recommends no change from the PEB determinations as not unfitting.  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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20210308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20210013428, XXXXXXXXXXXXX 

Dear XXXXXXXXXXXX:

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), 1835 Army Boulevard, Bldg. 2000, Fort Sam Houston, TX 78324.

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

Sincerely,