RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200492 DATE OF PERMANENT SEPARATION: 20030623 BOARD DATE: 20130228 DATE OF PLACEMENT ON TDRL: 20020502 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (25V/Combat Documentation and Production Specialist), medically separated for asthma. Despite treatment for asthma, the CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. The CI was originally issued a permanent P3 profile in 1998 and was referred for a Medical Evaluation Board (MEB). The MEB forwarded asthma and allergic rhinitis to the Physical Evaluation Board (PEB). In March 2002 the PEB adjudicated asthma as unfitting, rated 30% with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The PEB also determined that a permanent evaluation of the CI’s impairments was not yet possible. The allergic rhinitis was determined to be not unfitting and no rating was assigned. The CI concurred with these findings and he was placed on the Temporary Disability Retired List (TDRL). The CI was evaluated approximately a year later and in May 2003, the PEB rendered a final disability rating of 0%. The CI concurred with the PEB’s findings and waived a formal hearing but also wrote a letter asking to remain on active duty. The US Army Physical Disability Agency (USAPDA) determined the PEB had properly adjudicated the case and the CI was permanently separated. CI CONTENTION: “Asthma – I have asthma. While on active duty I took a methacholine challenge test. The only way to verify asthma. They put me out of the army due this test. After one year I took re-evalution for asthma. The medical facility gave me a PFT test and said I no longer had asthma. My PFT’s have always been in normal range. I had the VA give me another methacholine challenge. The results show I was asthmatic.” SCOPE OF REVIEW: The Board’s scope of review is defined in Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The rated asthma as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. TDRL RATING COMPARISON: Final Service IPEB – Dated 20030507 VA - (10 Mos. Pre Final Separation) On TDRL – 20020502 Condition Code Rating Exam Condition Code Rating TDRL Sep. Asthma 6602 30% 0% Asthma 6602 30% 20020820 Allergic Rhinitis Not Unfitting N/A Allergic Rhinitis 6522 0% 20020820 .No Additional MEB/PEB Entries. Other x 10 20020820 Combined: 0% Combined: 30% Original VA Rating effective 20020503 per VARD 20021009. ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation System (DES) fitness determinations and rating decisions for disability at the time of separation. The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation. Asthma. The initial MEB narrative summary (NARSUM) prior to TDRL entry was completed in January 2002. It stated the CI had been diagnosed with asthma after a methacholine challenge test (MCT) in 1997. Pre-bronchodilator pulmonary function testing (PFTs) was normal in December 2001 and no post-bronchodilator testing was completed. The pertinent findings are noted in the chart below. A VA Compensation and Pension (C&P) examination was completed approximately 2 months after TDRL entry and it documented the use of Singulair, Advair, and Proventil. PFTs were completed, the examination did not state whether the testing was done pre-or post-bronchodilator, the results were within normal limits. The Board directs attention to its rating recommendation for the time of TDRL entry based on the above evidence. The PEB determined the asthma condition was not stable for rating and the CI was placed on the TDRL instead of being permanently separated. The PEB rated the condition 6602 Asthma at 30% based on the daily use of both inhaled anti-inflammatory and bronchodilator medication (Advair) and oral bronchodilator medication (Singulair). The VA also assigned a 30% rating based on medications. There is no evidence of intermittent use of systemic steroids or post- bronchodilator PFT results that would warrant a rating greater than 30%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition at TDRL entry. Pulmonary Exam MEB ~4.5 Mo. Pre-TDRL entry VA C&P ~2 Mo. Post-TDRL entry and ~10 Mo. Pre-TDRL Exit MEB ~2.5 Mo. Pre-TDRL Exit FEV1 (% Predicted) 112% % not reported 106% FEV1/FVC 85% 79% 83% Meds Daily Singulair and Advair Proventil, Advair, and Singulair (Not using inhaler regularly) No medications in the past six months Comments Pre-Bronchodilator PFTs: normal spirometry; Daily oral bronchodilator therapy; “Normal spirometry” ; Not stated if PFTs are pre-or post-bronchodilator; PFTs source document missing; not stated if testing done pre-or post- bronchodilator; able to run 1+ mile without any problem; worked outdoors §4.97 Rating 30% 30% 0% A periodic TDRL evaluation was completed approximately 2 months prior to permanent separation from service. The accompanying NARSUM noted the CI reported that he had quit smoking 2 months previously and that he had not taken any medication in the previous 6 months. The findings are reported in the chart above. No further information about this condition is available until PFTs were completed by the VA in September 2010, more than 7 years after the CI separated. A C&P examination completed in October 2010 noted the CI had normal pre-bronchodilator PFTs and that he was using inhaled anti-inflammatory (Azmacort) and inhaled bronchodilator (Proventil) medications. The January 2012 VA rating decision (VARD) related to this examination refers to VA treatment records from 2010 and 2011 but these are not available in the record. At the C&P examination, the CI reported he required monthly visits to the emergency room due to his asthma. The Board directs attention to its rating recommendation based on the above evidence. At the time of exit from the TDRL, the PEB assigned a 0% rating for 6602 asthma because the CI did not meet the minimum rating criteria. The 2012 VARD continued the 30% rating for 6602 asthma based medication usage stating there was no evidence to support monthly emergency room visits. The record does not contain any information about the CI’s use of medications between the time of the periodic TDRL evaluation NARSUM in 2003 and the C&P examination in 2010. There is no evidence to show the CI was taking any asthma medication near the time of exit from the TDRL and permanent separation from service. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 reasonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition at the time of TDRL exit and permanent separation from service. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the asthma condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication at either the time of TDRL entry or at the time of TDRL exit and permanent separation from service. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING TDRL PERMANENT Asthma 6602 30% 0% COMBINED 30% 0% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120602, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXXX Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXXX, AR20130005354 (PD201200492) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)