RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200734 SEPARATION DATE: 20020806 BOARD DATE: 20130219 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (19D, Cavalry Scout) medically separated for asthma. He was treated, but was unable to fully perform his military duties or meet physical fitness standards. He was issued a permanent profile and underwent a Medical Evaluation Board (MEB). The MEB found his asthma condition medically unacceptable, and referred him to a Physical Evaluation Board (PEB). No other conditions were listed on the DA Form 3947. The PEB found the asthma condition unfitting, and rated it 10% IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with 10% disability. CI’s CONTENTION: “The VA awarded 30% for this condition.” SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44 is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The unfitting asthma condition meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below. No other conditions are within the Board’s purview. Any condition outside the Board’s defined scope of review may be eligible for future consideration by the Army Board for Corrections of Military Records. RATING COMPARISON: Army PEB – dated 20020617 VA (5 mos. Post-Separation) – Effective 20020807 Condition Code Rating Condition Code Rating Exam Asthma 6602 10% Asthma 6602 10%* 20030114 .No Additional MEB/PEB Entries. Not Service Connected x 4 20030124 Combined: 10#% Combined: 10% *The VA rating for Asthma was later increased to 30%, by a subsequent VA Rating Decision dated 20090320 ANALYSIS SUMMARY: The Board’s recommendations are premised on severity of conditions at the time of separation. The VA ratings which it considers in that regard are those rendered most proximate to separation. The Board’s operative instruction, DoDI 6040.44, specifies a 12- month interval for special consideration to VA findings. This does not mean that the later VA evidence was disregarded, but the Board’s recommendations are directed to the severity and fitness implications of conditions at the time of separation. Asthma. In May 2001, the CI developed symptoms of coughing and wheezing. He was seen in the Emergency Room and was treated for asthma. Allergy skin testing showed that he was allergic to molds and dogs. Treatment with anti-asthma medications caused his symptoms to improve. However, in spite of treatment, the CI’s respiratory problems continued and an MEB was initiated. His MEB clinical evaluation was at Fort Polk on 11 April 2002. At that time, he was being treated with inhaled Albuterol on an “as needed” basis. The CI reported that he was using his inhaler about twice a day. Albuterol is a short-acting beta adrenergic agonist, and it functions as a bronchodilator. Physical examination (PE) of his lungs was unremarkable, and showed no wheezing. Pulmonary function tests (PFTs) were done 9 days earlier and were repeated three times, in order to assure accuracy. The CI’s Forced Expiratory Volume in one second (FEV-1) was 84-85% of predicted. After bronchodilator, his FEV-1 went up to 88-95% of predicted. The PFTs were interpreted as normal spirometry. In January 2003, 5 months after separation from service, he had a VA Compensation and Pension exam. The CI reported that he was using his inhaler up to four times per day. PE was normal. There was no wheezing on inspiration, expiration, or forced expiration. Chest X-ray was normal. PFTs were normal. The examiner wrote, “The patient apparently has asthma by history only with good control and no functional impairment at the present time.” The PFTs in the treatment record, which were closest to the date of separation, and which the Board weighed in arriving at its rating recommendation, are summarized below. PFTs MEB ~4 mos. Pre-Sep (20020402) VA ~5 mos. Post-Sep (20030114) FEV-1 (% Predicted) 84-85% pre-drug / 88-95% post-drug 80% FEV-1/FVC (%) 82-84% pre-drug / 85-87% post-drug 85% Details 1st TEST: FEV-1 = 85%; FEV-1/FVC = 83% Post-drug: FEV-1 = 95%; FEV-1/FVC = 87% CONCL: Spirometry WNL (FEF25-75 went up 33% post drug) 2nd TEST: FEV-1 = 84%; FEV-1/FVC = 82% Post-drug: FEV-1 = 88%; FEV-1/FVC = 85% CONCL: Spirometry WNL (No change after bronchodilator) 3rd TEST: FEV-1 = 85%; FEV-1/FVC = 84% Post-drug: FEV-1 = 90%; FEV-1/FVC = 86% CONCL: Spirometry WNL (No change after bronchodilator) FVC was 94% of predicted value. Interpretation was: normal spirometry, gas transfer, and total lung capacity. Oximetry at rest on room air was 99%. §4.97 Rating 10%* 10%* * 10% based on inhalational bronchodilator therapy, not the PFT thresholds The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the evidence above. Both the Army PEB and the VA coded the asthma condition 6602, and rated it 10%. Several years later, the VA increased its asthma rating to 30%. In VASRD §4.97, rating guidance for asthma is based on clinical exacerbations, type & frequency of medications used, and results of PFTs. Using PFT data in the treatment record, the CI’s asthma was essentially non-compensable based on the PFT thresholds for diagnostic code 6602 (Asthma, bronchial). However; IAW VASRD §4.97, a 10% rating is warranted when there is satisfactory evidence of intermittent inhalational bronchodilator therapy. A 30% rating is warranted when there is satisfactory evidence of daily inhalational bronchodilator therapy. The crux of the Board’s deliberation centered on the frequency of the CI’s inhalational bronchodilator therapy. In the treatment record, there was sparse documentation of prescribed anti-asthma medication. The only medication profile available did not reflect regular refills of anti-asthma medications. There was no reference to outside pharmacy procurement of medications. The Board thus concluded that the CI did not require daily asthma treatment on a sustained basis, specifically not at the time of separation. In April 2002, he was using the albuterol inhaler twice a day. In January 2003, the CI reported that he was using his inhaler as often as four times a day. From the evidence in the treatment record, the Board concluded that it was more likely than not that the CI was using his inhaler on an intermittent “as needed” basis. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends by majority vote of 2:1 that there be no change in the PEB adjudication for the asthma condition. It is appropriately coded 6602, and meets the criteria in VASRD §4.97 for the 10% rating level. 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. In the matter of the asthma condition and IAW VASRD §4.97, the Board recommends by majority vote of 2:1, no change in the PEB adjudication. The single voter for dissent (who recommended 30%) did not elect to submit a minority opinion. 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 Asthma 6602 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120605, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20130004602 (PD201200734) 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 XXXXXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)