RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02064
BRANCH OF SERVICE:  Army	BOARD DATE:  20150203
SEPARATION DATE:  20061204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Petroleum Supply 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.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “asthma, moderate persistent” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “asthma with a history of shortness of breath” as unfitting, rated 0%.  The CI made no appeals and was medically separated.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20060929	VA* - (~6 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	0%	Asthma	6602	60%	20070604	
Other x 0 (Not In Scope)	Other x 8 (Not In Scope)	
RATING:  0%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20070621 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Asthma Condition.  The treatment record initially reflected that the CI developed shortness of breath (SOB) and chest tightness while running in early 2000.  The CI had no past history of asthma or allergic reactions.  At the time of her first Internal Medicine examination, her symptoms had resolved and her lungs were objectively clear.  A preceding methacholine challenge test (asthma definitive test) was consistent with asthma.  Lung X-rays were normal.  Initially, the CI was prescribed Albuterol (bronchodilator) rescue inhaler for symptomatic SOB and Flovent (inhalational steroid; fluticasone) in December 2001.  A month later, Singulair (oral indirect-acting bronchodilator) was added to her medication regimen.  A clinical encounter dated 1 August 2005 indicated that her asthma symptoms were increasing on medications of Advair (a daily inhalational steroid/long-acting bronchodilator combination) and Albuteral.  A pulmonary function test (PFT) performed on 4 May 2006 (7 months prior to separation) noted a mild restrictive lung pattern.  She was permanently profiled in June 2006 and referred for an MEB with the diagnosis of asthma.  Her physical restrictions addressed only running for she was allowed to perform sit-ups, push-ups, and unlimited walking, biking, and swimming.

At the MEB narrative summary of 7 July 2006 (5 months prior to separation), the CI’s present condition was described as an inability to perform outdoor activity, heavy strenuous exercise, or wear nuclear, biological, chemical protective equipment due to asthma exacerbations.  Her physical examination (PE) was normal.  The examiner noted the diagnosis as moderate persistent asthma and her current medications remained daily use of Advair and Albuterol.

At the VA Compensation and Pension (C&P) examination of 4 June 2007 (6 months after separation), the CI’s medication remained unchanged.  She endorsed asthma attacks occurring “every couple of months” and improved with inhaled medication.  The VA PE remained normal.  The PFT results as referenced above, with §4.97-ratable treatment criteria, are summarized in the chart below.
       DOS 20061204
Pulmonary Function	
Pulm/MEB ~ 7 Mo. pre-Sep (20060504)	
C&P ~ 6 Mo. post-Sep (20070604)	
FEV1 (% Predicted)	70%	55%	
FEV1/FVC	90%	116%	
Medications	Advair; Albuterol	Advair; Albuterol	
§4.97 Rating	30%	30%-60%	

The Board directed attention to its rating recommendations based on the above evidence.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  The non-PFT derived criteria are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%.  Having clear evidence of using inhaled anti-inflammatory medication on both prior to and after examinations easily met the 30% impairment level.  In considering PFT-derived criteria, Board members acknowledged that the VA C&P exam also met the 60% impairment level with an FEV-1 of 55%.  This single (55%) entry remained the primary point of discussion in this case.

In considering probative value between the two charted exams, members agreed that each exam was “near equivalent” in time reference to separation as well as exam accuracy and detail.  Members therefore, carefully reviewed the entire file for corroborating evidence prior to separation.  All prior PFT’s contained in the case file were older than 12 months from the date of separation and all but one maintained FEV-1 parameters indicative for either a 10% or 30% impairment rating.  Members deliberated over 30% or 60% ratings associated with each exam’s measured PFT findings.  Board members considered and agreed that despite the single measured FEV-1 of 55% within 6 months of separation, the totality of the evidence throughout the entire case file remained more consistent in meeting the 30% impairment criteria.  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.  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, 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 re-characterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Asthma 	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131101, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

AMR-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, AR20150010369 (PD201302064)

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