RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx	CASE:  PD1200957
BRANCH OF SERVICE: MARINE CORPS 	BOARD DATE:  20130523
SEPARATION DATE:  20030430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Cpl/E-4 (0311/Rifleman) medically separated for severe persistent asthma.  The CI was diagnosed with asthma after being referred to the pulmonary clinic for recurrent bronchospasm.  The asthma could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on light duty and referred for a Medical Evaluation Board (MEB).  The asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB found the severe persistent asthma unfitting, and rated it 10%.  The CI made no appeals, and was medically separated.

CI’s 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.  No additional conditions are within the DoDI 6040.44 defined purview of the Board, any conditions or contention not requested in his application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – dated 20030223	VA - (used STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Severe Persistent Asthma	6602	10%	No VA Entry for Asthma				
No Additional MEB/PEB Entries	Other x 2		
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20040315 (most proximate to date of separation [DOS]).  VARD of 20060418 awarded asthma w/bronchitis, 6602 at 30%, effective 20050602.  There was no VA exam for the asthma until 2011.  

ANALYSIS SUMMARY:

Asthma.  In 2001, the CI was diagnosed with severe, persistent asthma.  He was treated, but was unable to fully perform his military duties, and an MEB was initiated.  His MEB clinical evaluation was dated 1 October 2002.  At that time, his lungs were clear to auscultation.  His medications included:  Flovent (an inhaled corticosteroid), Serevent (a long-acting beta adrenergic bronchodilator), and Singulair (a leukotriene receptor antagonist).  Oral Prednisone was used as needed, to control asthma exacerbations.  On 13 February 2003, the CI was seen and evaluated in the pulmonary clinic at an MTF in Jacksonville.  The examiner noted that prednisone had been needed 2 weeks prior.  On examination, lungs were clear to auscultation with no wheezes.  Pulmonary function tests (PFTs) revealed a forced expiratory volume in one second (FEV-1) that was 110% of predicted.  His FEV-1 divided by forced vital capacity (FVC) was 74%.  The FEV-1 improved slightly with bronchodilator.  The examiner’s interpretation of the PFTs was, “mild obstruction with borderline response.”  Clinical assessment of the CI was, “severe persistent asthma, frequent prednisone use.”  Prescribed medications included Advair (an inhaled combination drug containing corticosteroid), Proventil (a short-acting “rescue” bronchodilator), and Singulair.  There was no evidence that Prednisone use (as needed) was discontinued.  As noted above, the CI was medically separated from service on 30 April 2003.  His severe, persistent asthma condition was coded 6602, and rated at 10%.  

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation based on the above evidence.  For the reader’s convenience, the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.97 language for the 10%, 30%, and 60% ratings (code 6602) is excerpted below:

FEV-1 of 40 to 55-percent predicted, or; FEV-1/FVC of 40 to 55 
percent, or; at least monthly visits to a physician for required care
of exacerbations, or; intermittent (at least three per year) courses 
of systemic corticosteroids ...................................................................................60 

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 .....................................................30 

FEV-1 of 71 to 80-percent predicted, or; FEV-1/FVC of 71 to 80 
percent, or; intermittent inhalational or oral bronchodilator therapy .................10

Using data from the treatment record, the Board determined that at the time of final separation from military service, the CI was being treated with daily inhalational corticosteroid anti-inflammatory medication.  This would justify a 30% rating.  There was also evidence for intermittent courses of systemic corticosteroids.  If the courses of systemic steroids were at least 3 per year, this would warrant a 60% rating.  A higher rating of 100% was not justified.  After due deliberation, the Board determined by majority decision that at the time of separation, it was more likely than not that the CI was requiring intermittent (at least three per year) courses of systemic corticosteroids.  Considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends by majority decision (2:1 vote) a separation disability rating of 60% for the severe, persistent asthma condition.  It is appropriately coded 6602, and IAW VASRD §4.97, meets criteria for the 60% 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 severe, persistent asthma condition, the Board recommends by majority decision (2:1 vote) a disability rating of 60%, coded 6602, IAW VASRD §4.97.  The single voter for dissent (who recommended a 30% rating) 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 the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Severe persistent asthma	6602	60%	
COMBINED	60%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120621, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

xx
President
Physical Disability Board of Review

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
                                  
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION

Ref:   (a) DoDI 6040.44
             (b) PDBR ltr dtd 12 Aug 13

      I have reviewed subject case pursuant to reference (a) and non-concur with the recommendation of the Physical Disability Board of Review as set forth in reference (b).  However, I found sufficient evidence to warrant an increase in the disability rating previously awarded Mr. xxxx.  Therefore, his records will be corrected to reflect a change in his disability rating from ten (10) percent to 30 percent with placement on the Permanent Disability Retired List effective the date of his discharge.

						  xxxx
						  Principal Deputy
						  Assistant Secretary of the Navy 
						     (Manpower & Reserve Affairs)