RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200859 SEPARATION DATE: 20020129 BOARD DATE: 20130205 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Soldier, PFC/E-3(63B/Light Wheeled Mechanic), medically separated for reactive airway disease (RAD). The CI began having shortness of breath, wheezing, and night coughing after arriving in Colorado in December 2000. He did not improve adequately with inhalational or oral medications to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded the Physical Evaluation Board (PEB) reactive disease as medically unacceptable IAW AR 40-501, and no other conditions for PEB adjudication. The PEB adjudicated the RAD as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: The CI states: “Lumbrosacral strain (sic), chondromalacia patella right & restrictive airway disease have all gotten worse and VA just want to keep giving me different meds. Hearing loss and tinnitus are the worst (sic) VA finally took it serious and found that I have lost 30% hearing in my left ear and the constant ringing in my ears gives me headaches and drive me crazy. Due to the pain and problems with my lumbrosacral strain and chondromalacia patella right I had to stop my career as a truck driver because I couldn’t perform my job duties anymore. The restrictive airway disease has gotten worse I have to use my inhaler 3 – 4 times at night I’m waken in middle of night not being able to breath (sic) with shortness or chest tightness. Hearing loss and tinnitus for years after getting out of military (sic) I told VA doctors I was having problems with hearing due to working in motor pool with no earplugs and they didn’t provide any earplugs in motor pool. The VA finally ran test on my hearing and ears and found that I have lost 30% hearing in my left ear and are still working on my hearing.” (sic) SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 Enclosure 3, paragraph 5.e. (2) 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 ratings for unfitting conditions will be reviewed in all cases. The other requested conditions, “lumbrosacral” strain, chondromalacia patella right, hearing loss, and tinnitus are not within the Board’s 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 Corrections of Military Records. RATING COMPARISON: Service PEB – Dated 20011121 VA (1 & 3 Mos. Post-Separation) – All Effective Date 20020130 Condition Code Rating Condition Code Rating Exam Reactive Airway Disease 6602 10% Restrictive Airway Disease 6602 10% 20020220 .No Additional MEB/PEB Entries. Chondromalacia Patella, Right 5260-5014 10% 20020220 0% X 2 / Not Service-Connected x 2 20020220 Combined: 10% Combined: 20% ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment and worsening severity with which his service-incurred condition continues to burden him. It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. This role and authority is granted by Congress to the Department of Veterans Affairs (DVA). The Board utilizes DVA 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. The Board’s authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. Post- separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation. Reactive Airway Disease. The CI developed respiratory symptoms that included shortness of breath, chest tightness, wheezing and night time coughing in December 2000. Although asthma was clinically suspected, evaluation with baseline pulmonary function testing (PFT), methacholine challenge testing, and exercise PFTs did not provide objective evidence of airway hyper-responsiveness characteristic of asthma or RAD. There were two PFTs in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below. Pulmonary Exam PFT ~12 Mo. Pre-Sep PFT ~5 Mo. Pre-Sep FEV1 (% Predicted) 103% 88 FEV1/FVC 91% 89 Meds None Serevent, Flovent, Singulair daily; albuterol as needed §4.97 Rating 0% 30% (PEB 10%*) *30% based on medications, not PFT results An outpatient note on 7 September 2001 (5 months prior to separation) documented the daily use of Flovent (inhaled steroid), Serevent (inhaled bronchodilator) and as-needed Albuterol (inhaled bronchodilator). The MEB examination on 2 October 2001 documented current medications that included Flovent, Serevent and Albuterol. Physical examination was normal. The narrative summary examiner on 31 October 2001 (3 months prior to separation), indicated that the CI used Albuterol (inhaled bronchodilator) every other day. It was also noted that Serevent and Flovent had been prescribed, but it was not specified if they were currently being used. A review of the available service treatment record found no physical examination that documented wheezing. There was one documented prescription for a course of Prednisone (systemic steroid) on 11 July 2001. The VA Compensation and Pension exam on 20 February 2002 (a month after separation) noted the CI was on “five different kinds of asthma pumps” but did not specify what those medications were. A review of the outpatient VA record found two nursing intake notes within 4 months after separation indicating there were no prescriptions on file for asthma. A VA pharmacy printout covering February 2002 – August 2004 also showed no asthma medication prescriptions during that time period. And a VA note on 13 August 2004 reported that the asthma condition had caused “no problems since military.” There were no documented visits for asthma during the year after separation. The Board directs attention to its rating recommendation based on the above evidence. The PEB’s 10% rating was based on an “as needed” use of a bronchodilator under the 6602 code (asthma), while the VA’s 10% rating under the same code was for “intermittent inhalational therapy.” While the PFT results in this case did not support a minimal rating, IAW §4.100 a 30% rating is justified for “daily inhalational or oral bronchodilator therapy, or; inhalational anti- inflammatory medication.” In assessing the frequency of medication usage however, the Board noted contradictory evidence. While the record documents prescriptions for daily bronchodilator and inhaled corticosteroids prior to separation, Board members debated the significance of apparent cessation of symptoms accompanied by a clear lack of need for medications after separation. Board members ultimately agreed that the evidence at hand does not support a rating higher than the PEB’s 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the RAD condition. 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 RAD condition and IAW VASRD §4.100, the Board unanimously recommends no change in the PEB adjudication. 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 Reactive Airway Disease 6602 10% RATING 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120604, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX, AR20130004071 (PD201200859) 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 XXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)