RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201917 BRANCH OF SERVICE: ARMY BOARD DATE: 20130411 SEPARATION DATE: 20030815 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistics Specialist) medically separated for asthma. The CI began having symptoms of shortness of breath in 2002 and was diagnosed with exercise induced asthma. He was treated with medication therapy but his condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The asthma condition, characterized as “exercise induced asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “exercise induced asthma with normal spirometry” as unfitting, rated 10% with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% combined disability rating. CI CONTENTION: The CI elaborated no specific contention in his application. SCOPE OF REVIEW: The Board’s scope of review is defined in 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. The rating for the unfitting asthma condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20030513 VA - (1 Mos. Pre Separation) Condition Code Rating Condition Code Rating Exam Exercise Induced Asthma 6602 10% Asthma 6602 10% 20030715 No Additional MEB/PEB Entries Other x 5 20030715 Combined: 10% Combined: 30% Derived from VA Rating Decision (VARD) dated 20030818 (most proximate to date of separation [DOS]). ANALYSIS SUMMARY: Asthma. The narrative summary (NARSUM) of March 2003 notes the CI was diagnosed with exercise induced asthma with little symptom improvement on medications. The CI had been a positive intradermal purified protein derivative (IPPD) converter and had completed medication (INH) treatment. At the MEB exam, the CI reported shortness of breath (SOB) with any significant exertion. The MEB physical exam, exam 5 months prior to separation, noted a normal lung exam and pulmonary function testing (PFT) documented FEV-1 of 88% predicted and FEV-1/FVC of 105% predicted with a history of a positive Methacholine challenge test (MCT). Restrictions were no Mission Oriented Protective Posture (MOPP) training (unable to wear protective mask), and unlimited walking with all other aerobic conditioning exercises at own pace. Current medications were listed as “Advair, Singular and Albuterol p.r.n.” Chest radiograph in May 2002 was normal. Three months prior to separation, the PEB disability description stated: “Exercise induced asthma, with normal spirometry. On intermittent Inhalational bronchodilator therapy. (MEBD DIAG 1 AND NARSUM) The NARSUM states soldier is taking Singulair and using an Advair inhaler daily, with Albuterol as needed. The medication profile shows that he received 60 Singulair tablets on 16 September 2002 and two Advair inhalers on 13 September 2002. Neither medication is adequate for daily therapy for 8 months.” Treatment note dated 16 December 2002 indicated in the automated “Current Medication:” area that Advair Diskus inhaler was last filled 30 September 2002 with 2 refills and the last Singulair filled was 16 October 2002. At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported being treated with Albuterol which helped, and stated “he gets flare-ups only with strenuous activity or exercise.” Exam showed normal lungs and the diagnosis was exercise induced asthma. The Board directs attention to its rating recommendation based on the above evidence. In its deliberations the members devoted ample attention to the issue of whether the requirement for daily bronchodilator and/or anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97 in this case given the normal PFTs. Although there was some question on the exact amounts and timing of medication prescription and use, the PEB disability determination of intermittent medication use was matched by the VA exam history and rating determination of intermittent medication usage. Members agreed that there was not adequate reasonable doubt favoring the CI in support of daily medication use to support a rating recommendation higher than 10% IAW the criteria defined in VASRD §4.97. 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. The Board concluded therefore that this condition could not be recommended for additional disability rating. 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. 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 Exercise Induced Asthma 6602 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120624, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Director of Operations Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009565 (PD201201917) 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 xxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)