RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01204
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140815
SEPARATION DATE:  20051215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (0811/Field Artillery Cannoneer) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The asthma condition, was forwarded to the Physical Evaluation Board (PEB) SECNAVINST 1850.4E.  The MEB also identified and forwarded gastroesophageal reflux disease (GERD) for PEB adjudication.  The Informal PEB adjudicated “extrinsic asthma" as unfitting and rated it at 0% with likely application of SECNAVINST 1850.4E.  The IPEB also rated “environmental allergies” as Category II condition (related to and contributing to the unfit condition and GERD as a Category III condition (not separately unfitting and not contributing to the unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his 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 condition is addressed below.  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 20051031 | VA - (7 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Extrinsic Asthma | 6602 | 0% | Asthma | 6602 | 60% | 20060719
Environmental Allergies | Category II | Allergies | 6599-6522 | 0% | 20060719
Other x1 (Not in Scope) | Other x7 | 20060719
Combined:  0% | Combined:  60%
Derived from VA Rating Decision (VARD) dated 20060727 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Asthma Condition:  The CI had a history of asthma as a child, which he outgrew by the time he reached 10 years of age.  In November 2004, 13 months prior to separation, he began having shortness of breath, cough and wheezing with exercise.  He was evaluated in the pulmonary clinic and diagnosed with asthma.  After pulmonary function testing was performed (see chart below), he was started on daily inhaled bronchodilator and anti-inflammatory medications.  He was also noted to have symptoms of allergies and after allergy testing revealed numerous environmental allergies, he was started on immunotherapy.  The immunotherapy did not result in a substantial decrease in his asthma symptoms.  The narrative summary completed 2 months prior to separation confirmed the above historical summary.  The CI was taking the following medications: Advair twice daily; Singulair daily; Nasonex nasal spray, Albuterol as needed, Allegra twice daily; and Xolair, subcutaneous injections every 2 weeks.  The physical exam revealed a normal lung exam.  Chest X-ray was also normal.  The provider’s impression contained the following statements, “…with moderate to severe persistent asthma…which despite maximal medical therapy continues to have severe symptoms which prevent him from achieving the exercise tolerance that is required for a fully deployable Marine Corps….”  At the VA Compensation and Pension (C&P) exam performed 7 months after separation, the CI reported that his medication regime did not include Advair.  He was awaiting formulary approval to re-start the Advair, which had proved much more efficacious in the past.  He was waking 2-3 times at night with shortness of breath and required bronchodilator therapy.  There were no hospitalizations due to asthma.  The physical exam revealed wheezing in both lung fields.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA applied VASRD code 6602 (bronchial asthma).  The PEB document does not elaborate on how it arrived at the 0% rating; however, the Joint Disability Evaluation Tracking System document contains an entry that suggests an FVC of 85% predicted was used to arrive at the 0% rating.  The VA’s 60% rating was based on an FEV1/FVC of 54%; however, the C&P exam documents that the CI was not on the most efficacious medication, Advair, at that time.  The Board reviewed all evidence proximate to separation and agreed that the CI’s requirement for daily inhaled anti-inflammatory medication (30% rating) was supported; while the pulmonary function test evidence supports a 10% rating IAW VASRD §4.97.  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.  As discussed above, PEB reliance on SECNAVINST 1850.4E for rating Asthma was operant in this case and the condition was adjudicated independently of that instruction by the Board.  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 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 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 29 Mar 15 ICO XXXXXXXXXXXXXX   
	 (c) PDBR ltr dtd 25 Mar 15 ICO XXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Mar 15 ICO XXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX

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

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

     a. XXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

     b. XXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

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

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

     e. XXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a disability rating of 30% 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.

	XXXXXXXXXXXXXX
	Assistant General Counsel
                                       (Manpower & Reserve Affairs)

PD-2014-01204