RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-00179
BRANCH OF SERVICE:  Army	BOARD DATE:  20140710
SEPARATION DATE:  20021018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E5 (92A20/Automated Logistics Specialist) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  The CI was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “asthma, mild persistent on medication” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition. The Informal PEB adjudicated “asthma (for which soldier is supposed to be using daily medications)” as unfitting, rated 0%, with likely application of DoDI 1332.39.  The CI appealed to the Formal PEB (FPEB) which adjudicated “asthma requiring intermittent use of medication” as unfitting, rated 10%.  The CI was medically separated without further appeal.  

CI CONTENTION:  The CI elaborated no specific contention in her 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 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 FPEB – Dated 20020716	VA - (1 Mos. Pre -Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma Requiring Intermittent Use of Medications	6602	10%	Asthma	6602	30%	20020911*	
Other x 1 (Not in Scope)	Other x 2	20020911	
Combined:  10%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20021020 (most proximate to date of separation ).  

ANALYSIS SUMMARY:  The VA Compensation and Pension (C&P) exam and multiple service treatment records (STR) were not available in evidence before the Board and could not be located after appropriate inquiries.  Further attempts at obtaining the relevant documentation would likely be futile and introduce additional delay in processing the case.  

Asthma Condition:  The narrative summary (NARSUM) notes the CI to reports a five-year history of symptoms of asthma to include shortness of breath, wheezing and chest tightness related to exercise and seasonal upper respiratory infections (URI).  This condition was treated from 1996 to 2000 with intermittent inhaled bronchodilator, and oral and inhaled steroid medication with relative control of the disease.  In September of 2000, the CI was seen in the emergency department with asthma symptoms and was treated with 2 courses of oral steroids.  In February 2001 the CI reported increased asthma symptoms with exacerbations associated with exertion, wet days and seasonal URI.  She reported using daily inhaled steroids and inhaled bronchodilators before any activity and inhaled broncho-dilators, as need, for acute episodes (rescue).  On 29 August 2001, while deployed to Germany, the CI developed a significant exacerbation of her symptoms, described as ‘life threatening”, requiring intensive care unit admission, intubation, and two days of ventilator respiratory support.  She was discharged, on 3 September 2001 on daily inhaled steroids and inhaled bronchodilators as needed for rescue.  The CI was seen in the emergency department 3 days later for exacerbation of her asthma and was treated with oral steroids (prednisone).   The following pulmonary clinic visit, on 26 September, the CI reported that she was “at her base line” and had only used her rescue inhaler twice since discharge.  On the MEB/NARSUM evaluation on 26 September 2001, 12 months before separation, the CI was reported taking daily Pulmicort, and albuterol before exercise and as needed for rescue.  The MEB physical exam noted the CI was in no distress and pulmonary exam was normal.  Pulmonary function test (PFT) obtained on 4 February 2002 revealed a forced vital capacity (FVC) of 99%, forced expiratory volume-1 (FEV-1) of 93 % and FEV-1/FVC of 94% and was consistent with an asthma condition.  Medical profile records, document the CI to have filled prescriptions for Pulmicort and albuterol in April 2002, the third refill with 2 remaining for each.  There are no entries in the STRs from this time, to the date of separation, 18 October 2002.  This included the VA C&P exam performed on 11 September 2002 as noted above.  

The Board directs attention to its rating recommendation based on the above evidence.  Both the FPEB and the VA rated asthma condition, under code  6620, asthma, bronchial, IAW §4.97 but at different rating levels; the FPEB rated 10% citing intermittent use of medication; and the VA, 30%, citing use of daily inhalational therapy as noted above.  Under code 6620, a rating of 10% requires, FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, on PFT; or intermittent inhalational or oral bronchodilator therapy.  A higher code of 30% requires 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.  The Board agreed that the data available for consideration was incomplete.  However, the Board unanimously concluded that the totality of evidence available reasonably supported a 30% rating for a condition requiring, and the continued use of, anti-inflammatory medications.  The Board agreed the asthma condition was not compensable under PFT criteria.  The Board found no other applicable codes for consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the asthma 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.  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board 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 her prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130417, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20140018666 (PD201300179)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						
CF: 
(  ) DoD PDBR
(  ) DVA