RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	 CASE:  PD-2013-02043
BRANCH OF SERVICE:  Army	 BOARD DATE:  20140711
SEPARATION DATE:  20040318

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E3 (63B/Light Vehicle Mechanic) medically separated for asthma.  The asthma could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The respiratory condition, characterized as “asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “asthma with intermittent use of albuterol” as unfitting, rated 10% with likely application of Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “I was diagnosed with diabetes because of the lack of ability to preform physical activity due to the asthma that developed during time in service.  As well as the inability to fully use my right knee also due to injury during time in service.”  [sic] 

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; the diabetes and right knee conditions are not 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 20031112	VA - (> 6 Yrs. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20100721	
Other x 0 (Not in Scope)	Other x 2	20100721	
Rated:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20100811 (most proximate to date of separation ).   

ANALYSIS SUMMARY:  

Asthma Condition:  The service treatment record indicated the CI, a light vehicle mechanic stationed in Germany, presented in January 2001 with an acute onset of shortness of breath and difficulty breathing.  He was diagnosed as having status asthmaticus (a prolonged asthma attack) and was hospitalized.  He was treated with steroid and inhalation therapy with recovery within 24 hours.  For the next 3 months, he was maintained on steroids and used inhalers 2 to 3 times a day.  An allergy evaluation determined that the CI’s chief complaint had been shortness of breath while running.  He denied childhood asthma and smoked from ages 17-21.  The Board noted that on a 28 March 2003 exam, the CI was recorded as being non-compliant with medications but was using the Albuterol 2 to 3 times a day, diet and exercise program (and had gained 15 pounds since last visit; enlistment medical examination in 1999, he weighed 208 pounds, but was up to 240 pounds in June 2003).  It’s noted that he had not been hospitalized or gone to the emergency room.  Asthma symptoms precipitants were reported to be colds, exercise, flu, and possibly cold air.  He had no history of eczema, hives, or allergies to food, drugs, or insects.  Skin testing was positive for allergies to trees, grasses, and weeds.  A set of pulmonary function tests (PFT) on 16 June 2003 showed a forced vital capacity (FVC) of 48% pre-medication and 67% post and a forced expiratory volume (FEV) of 79% pre medication and 76% post.  These appear to be tests done in the clinic rather than formal PFTs and are significant outliers from other testing in the record, reducing the probative value.  However, the Board did note that the CI was symptomatic (6 to 7 out of 10) at the visit.  At the MEB examination on 1 October 2003, the CI reported asthma, shortness of breath, bronchitis, wheezing and indicated he used an albuterol inhaler as needed.  The MEB physical exam noted no wheezing.  The commander’s statement dated 2 October 2003 indicated the CI remained “on good terms and currently suffered no major effects while working.”  “His endurance level and physical fortitude have lowered due to his asthmatic condition.”  He occasionally had shortness of breath when required to work at excessive rates, which required him to take sporadic resting periods, was hindered from wearing a protective mask or entering a gas chamber and was not deployable.  The narrative summary dated 10 October 2003 noted his chest was clear without wheezes.  Spirometry (lung function) testing to determine pulmonary status revealed a FVC of 78%, FEV1 was 75%, and the maximum mid-expiratory flow was 66%.  X-rays of the chest were clear without gross pathology.  Pulmonary work-up included an exercise challenge, after 5 minutes FEV1 dropped 9% and at 10 minutes dropped 20%, thereby meeting the criteria for exercise induced bronchospasm and there was bronchiolar hyperactivity with positive methacholine challenge (a test to induce asthma symptoms.)  The examiner noted that the CI used an inhaler 2 to 3 times a day.  The Board noted that this history is different than previously recorded when the CI was noted to use it 2 to 3 times a week or as needed other than the 28 March note.  The CI received a permanent P3 profile for asthma on 16 October 2001 but was authorized an alternate aerobic event (walk) for physical fitness testing.  He passed his physical fitness tests in 2001, 2002 and the last one on 17 May 2003.  At the VA Compensation and Pension examination dated 20 February 2010, performed over 6 years after separation, the CI reported a history of asthma with intermittent use of an inhaled bronchodilator (albuterol).  He reported that sometimes he had to take a break to use his inhaler and went back to work, but there were no effects of the problem on his usual daily activities.  Pulmonary function studies, including FVC, FEV1-84%, FEV1/FVC ratio-86%, were within normal limits.  The air resistance was normal.  There was no significant response to bronchodilators and the diffusing capacity was normal.  

The Board directs attention to its rating recommendation based on the above evidence.  The CI was diagnosed with exercise induced asthma and at the time of separation used an inhalational bronchodilator.  He was found to be unfit by the PEB, rated 10% using VA code 6602.  The VA likewise rated the CI 10% using code 6602.  The CI did not have PFT limitations warranting a 30% rating nor was he taking inhalational anti-inflammatory medication at the time of separation.  The majority of the clinical notes leading up to separation indicate usage of the bronchodilator less than daily.  This intermittent usage was also documented at the time of the VA examination, performed more than 6 years after separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination 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.  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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130918, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150002520 (PD201302043)

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