Author: JOHN J. D'ORAZIO
Last saved by: WEATHERS, JANICE R SrA USAF AFRBA AFRBA/AFBCMR
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD1300352
BRANCH OF SERVICE:  Army	BOARD DATE:  20130924
SEPARATION DATE:  20050114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92F10/Petroleum Supply Specialist) medically separated for an asthma condition.  The CI began having exertional wheezing and chest tightness in 2003, and was diagnosed with asthma in 2004.  The asthma could not be adequately prevented to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  A moderate persistent asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated the asthma condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contentions.

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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20041118 | VA* - Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma | 6602 | 10% | Asthma | 6602 | 10% | STR
No Additional MEB/PEB Entries | Other x 5 | STR
Combined:  10% | Combined:  40%
* Derived from VA Rating Decision (VARD) dated 20051024 (most proximate to date of separation)

ANALYSIS SUMMARY:  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.

Asthma Condition.  The CI began reporting symptoms of wheezing and coughing without shortness of breath (SOB) in June 2003.  He continued to report the same symptoms throughout 2003 with visits to the emergency rooms for the diagnosis of bronchitis.  Although not diagnosed with asthma and with no report of SOB, the CI was prescribed Albuterol for daily use and Azmacort throughout 2003 and most of 2004.  Initial pulmonary function test (PFT) completed on 1 July 2003 was normal; however, repeated PFT conducted on 9 September 2004 was consistent with the diagnosis of asthma and was interpreted as moderate obstructive disease with a notation that restrictive disease could not be ruled out.  FEV1/FVC (forced expiratory volume/forced vital capacity) pre-drug was noted at 77%, post-drug at 96% of predicted.  A third PFT performed on 22 October 2004 recorded a pre-drug FEV1/FVC at 92% value and 102% post-drug; consistent with the diagnosis of mild obstructive disease.  Symptoms included SOB, cough, chest pain and wheezing.  The CI presented to the emergency room on two occasions with report of SOB, chest pain, and cough; he was diagnosed with panic attacks both times.  There was only one emergency room visit for the treatment of asthma (6 November 2004), a year prior to separation.  Other presentations to the ER were for treatment of acute bronchitis.  All radiographs of the chest were normal.  There was no pulmonary medicine consult or methacholine challenge study provided to the CI.  The CI was placed on a permanent P3 profile dated 5 October 2004 with restrictions of exposure to chemicals, fuels, excessively dusty environments and no training with a gas mask.  Treatment records indicated the CI was prescribed Albuterol inhalational therapy daily and the medication profile noted the CI regularly refilled his prescriptions.  At the MEB narrative summary (NARSUM) evaluation performed on 22 October 2004, approximately 2 months prior to separation, the CI reported wheezing and chest tightness associated with physical activity and some relief of symptom with Albuterol inhaler.  The CI noted he had experienced 10 asthma attacks in September 2004, two of which he was seen in the emergency room for and given Albuterol and oral steroids.  Physical exam recorded the CI’s height of 68 inches and weight of 230 pounds.  Lungs were clear without wheezing and cardiac exam was normal.  The examiner diagnosed moderate persistent asthma and documented daily use of Albuterol and Advair.  The CI was non-attendant for the VA Compensation and Pension exam.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the condition at 10% under VASRD code 6602 (asthma).  The PEB cited the condition not requiring daily inhalational medications as evidenced by medication profile, FEV-1 at 109% post bronchodilator.  The Board deliberated whether a 30% rating level was supported by the evidence at hand.  VARD code 6602 states “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” renders a 30% rating.  The Board noted that the NARSUM and multiple entries found in the service treatment record, months prior to separation, documented that daily use of inhaled anti-inflammatory medication (Advair, Azmacort or Flovent) and daily inhalational bronchodilator therapy (Albuterol) were prescribed.  Board consensus was that the 30% rating criteria were reasonably supported by the evidence at hand.  The Board found no pathway to a higher rating using any applicable VASRD code.  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 by a vote of 2:1 recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent, who recommended 10%, did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  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 his 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 20130511, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review

SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20130021949 (PD201300352)

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						XXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD1300352