RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-02522
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141024
SEPARATION DATE:  20060202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (LN/Legalman) medically separated for an asthma condition.  This condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was placed on limited duty and referred for a Medical Evaluation Board (MEB).  Unspecified asthma, with mention of status asthmaticus was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated bronchial asthma as a pre-existing condition and did not render a rating.  The CI appealed to the Formal PEB (FPEB) which adjudicated the bronchial asthma as Category I (unfitting), rated 10% with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be Category IV (not constituting a physical disability).  The CI made no additional appeals and was medically separated.

CI CONTENTION:  “The medical issue was worst [sic] during my time of discharge.  This condition was rated at 100% employable by the VA after discharge.  My question is how the military rated me at 10% and VA 100%?  Now I receive 30%.” 

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.  Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.  

RATING COMPARISON:

Service IPEB – Dated 20051201	VA* - (16.1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bronchial Asthma	6699-6602	10%	Asthma	6602	100%	20070531	
Other x 1 (Not in Scope)	Other x 5	
Combined:  10%	Combined:  100%	
*Derived from VA Rating Decision (VARD) dated 20060801 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  The Board also acknowledges the CI’s contention that suggests a higher service rating should have been granted on the unfitting medical condition documented at the time of separation.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Bronchial Asthma.  The CI reported pre-service history of asthma with asthma-related hospital admissions.  She had used a metered dose inhaler regularly to address shortness of breath (SOB) and wheezing symptoms.  She was able to enter the service without the use of her inhaler; however, shortly afterwards she was back on the inhaler on an as needed basis to address new episodes of mild asthma attacks.  The CI was prescribed an oral steroid medication prior to deployment and was taking the medication at the time of the flare-up that prompted her evacuation from Iraq in June 2004.  Her symptoms were SOB and wheezes.  She presented to emergency care on 3 June 2004, where she was evaluated and diagnosed with acute asthma exacerbation.  The clinician prescribed daily use of an anti-inflammatory-steroid inhaler on a twice-a-day schedule.  At a pulmonary evaluation performed on 30 August 2004, the CI had normal pulmonary function studies and a pulmonary challenge test consistent with moderate-severe asthma.  The CI’s asthma related symptoms had not improved significantly which resulted in the addition of another steroid inhaler and a daily dose of Prednisone (an anti-inflammatory [steroid based]) and rescue inhaler that continued for several months.  A pulmonary entry, dated 29 November 2005, noted the CI was steroid dependent and had continued to use both a steroid inhaler and an oral steroid.  Treatment records showed no evidence of frequent emergency room visits or hospitalizations for asthma, or episodes of respiratory failure.

The MEB narrative summary (NARSUM) evaluation dated 24 August 2005 (5 months prior to separation) noted the CI reported she continued to experience asthma symptoms of SOB and wheezing.  She reported she could not run for half a mile without becoming symptomatic.  The physician noted the CI continued to use Prednisone twice a day.  The physician noted the methacholine challenge test for asthma recorded a 35% reduction in FEV-1 that normalized after inhaler treatment.  The pulmonary function tests were normal.  The computerized tomography (CT) chest scans were negative for any significant pathology.  Physical examination was not recorded.  The physician opined that the CI’s condition had not improved significantly to allow her return to full duty.  The medication profile demonstrated multiple, regular, prescriptions for oral and inhaled steroid-based anti-inflammatory medications.

The VA Compensation and Pension (C&P) examination performed on 31 May 2007; more than a year after separation, recorded the CI had continued daily use of inhaler and used the rescue inhaler every 2 days.  She suffered from environmental allergies that often triggered asthma attacks.  Pulmonary function tests were slightly reduced (FEV-1 at 94% pre-treatment and 97% post).  Physical examination was normal.  The physician stated, “The diagnosis is changed to uncontrolled allergic asthma, based on the CI’s symptoms, ER visits, frequent asthma attacks throughout the week and use of nebulizer daily…”

The Board directs attention to its rating recommendation based on the above evidence.  The PEB initially found the condition of asthma unfit but existed prior to service and not ratable.  On reconsideration, the FPEB rated the condition at 10% coded analogously 6699- 6602, citing that “New evidence documented that the member’s asthma is steroid dependent…the condition existed prior to service (EPTS) but was asymptomatic and did not require medication or interfere with activities, an EPTS factor less 0% is appropriate.  Therefore,…the most appropriate disability rating of 10%.”  IAW VARD §4.97 and VASRD code 6602 (asthma, bronchial), an evaluation of 10% is granted whenever there is forced expiratory volume in one second (FEV -1) of 71% to 80% of predicted value; or the ratio of FEV -1 to forced vital capacity (FEV1/FVC) of 71% to 80%; or intermittent inhalational or oral bronchodilator therapy.  A higher evaluation of 30% is warranted if there is FEV -1 of 56% to 70% predicted; or FEV –II FVC of 56% to 70%; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.”  The Board agreed that a 10% was supportable by the use of intermittent inhaler therapy.  The Board deliberated whether a 30% rating level was supported by the evidence at hand.  The Board noted that both the NARSUM and C&P evaluations documented the use of daily inhaled anti-inflammatory medication.  The medication profile recorded continuous prescriptions for anti-inflammatory medications.  The Board further noted, the PEB in its final report implied daily steroid medication use, noting “medical evidence documented that the CI was steroid dependent.”  The PEB subtracted an EPTS factor of less 0%.  The Board opined the CI to have moderate-severe asthma that was controlled by daily medication.  The Board unanimously agreed that the 30% rating criteria were reasonably supported by the evidence at hand.  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 §4.3 (reasonable doubt).  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	
Bronchial Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131108, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:    (a) DoDI 6040.44
        (b) PDBR ltr dtd 24 Apr 15 ICO XXXXXXXXXXXXXXX    
        (c) PDBR ltr dtd 24 Apr 15 ICO XXXXXXXXXXXXXXX
        (d) PDBR ltr dtd 8 Jan 15 ICO XXXXXXXXXXXXXXX
        (e) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
        (f) PDBR ltr dtd 21 Apr 15 ICO XXXXXXXXXXXXXXX
        (g) PDBR ltr dtd 7 Apr 15 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (g).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.

	XXXXXXXXXXXXXXX
	Assistant General Counsel                                          	(Manpower & Reserve Affairs)