RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00712
BRANCH OF SERVICE:  Army	BOARD DATE:  20150114
SEPARATION DATE:  20071116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Basic Trainee) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he was authorized to perform an alternate aerobic physical fitness event.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “asthma, moderate to severe” 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” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was rated at a lower rating by the armed services and the received a higher rating by the Department of Veteran Affairs.  Was rated for some areas but not others.”

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 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:

Service IPEB – Dated 20071023 | VA Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma… | 6602 | 10% | Asthma | 6602 | 10% | STR
Other x 0 (Not In Scope) | Other x 0
RATING:  10% | RATING:  10%
Derived from VA Rating Decision (VARD) dated 20080228 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma Condition.  The STR documents that the CI sought care for chest discomfort, shortness of breath (SOB) with exertion, and dizziness in February 2007 shortly after assignment in Texas for advanced training.  He was evaluated by a cardiologist who noted that the 70 inch CI weighed 260 pounds (up from 232 pounds on the 12 July 2006 accession exam).  His lungs were clear and respirations unlabored.  The cardiac evaluation was unremarkable other than a slight anemia.  On 2 March 2007, a primary care note documented that he smoked eight cigarettes a day, but that his lungs were clear.  Three weeks later, his symptoms were worsening, but the lung exam remained normal.  A 30 March 2007 chest X-ray showed findings suggestive of asthma (hyperinflation and bronchial wall thickening).  He was seen by pulmonary medicine that day.  He reported labored breathing and wheezing, but his lungs were clear on exam.  The diagnosis of asthma could not be excluded and medications begun.  Pulmonary function tests (PFTs) were not performed until 4 April 2007.  These showed normal values, but with a good improvement after a bronchodilator.  This raised the question of small airway disease (seen in both asthmatic individuals and smokers as well as with other lung conditions).  There was also the suggestion of possible poor inspiratory effort versus diastolic dysfunction (cardiac).  The Board observed that the CI had already been evaluated for cardiac disease and none was found.  The poor effort could have been volitional or reflective of the obesity.  The 5 April 2007 pulmonary consult interpreted the PFTs performed that day as suggestive of asthma and he was started on an inhaled corticosteroid.  On 14 May 2007, a military pulmonologist reported the episodic dyspnea had been extensively evaluated by a civilian pulmonologist and cardiologist.  The CI reported similar symptoms during his high school athletic years.  This was the basis for the PEB determination that the asthma was an “existed prior to service” (EPTS) condition.  His symptoms responded well to inhaled bronchodilators.  The CI also noted new onset of seasonal allergic rhinitis (hay fever) symptoms, which were confirmed by laboratory studies.  Listed medications included a daily inhalational anti-inflammatory and bronchodilator medications.  He continued to smoke.  

Physical exam revealed diffuse wheezing in all lung fields.  The 14 May 2007 PFTs showed mild restriction (which is more consistent with obesity than asthma) with a significant response to bronchodilator (which is consistent with asthma).  A 14 May 2007 chest X-ray was normal; previously it had shown changes suggestive of asthma.  However, a chest CT that day showed findings consistent with small airway disease.  The 30 May 2007 MEB narrative summary (NARSUM), 6 months prior to separation, recounted the history and diagnostic workup to date.  The medications included a daily anti-inflammatory and bronchodilator agent.  The NARSUM cited the physical exam and findings from the above pulmonary note dated 15 May 2007.  A prescription was given in August 2007 for a smoking cessation medication to be used over a 12-week period (which would extend to separation).  The Board observed that the CI reported that he smoked up to 1.5 packs per day, a significant level of abuse.  The 2 October 2007 addendum for the PEB noted that the CI reported having asthma symptoms prior to entering the military and that they had worsened since being stationed in Texas for training.  The 14 May 2008 VARD recorded findings from the 24 April 2008 (5 months after separation) VA Compensation and Pension (C&P) examination (not otherwise in evidence) which showed normal PFTs off of any inhalational medication or oral bronchodilator therapy.  The VA rater did not note if he was smoking, but the C&P examination was 6 months after the projected date of smoking cessation (implied from the medication regimen).  

The pulmonary function tests and ratable criteria considered by the Board are recorded in the chart below.

Pulmonary Exam | Pulmonary ~ 6 Mo. Pre-Sep | VA ~ 5 Mo. Post-Sep
FEV1 (% Predicted) | 84% | 97.7%
FEV1/FVC | 80% | 85%
Meds | Advair, Qvar, Singulair, Proventil | No medications
§4.97 Rating | 30% (Medications) | 0%
The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the asthma at 10% and used VASRD code 6602 (asthma, bronchial) noting EPTS and permanent service-aggravation.  The 28 February 2008 VARD rated the asthma at 10% (6602) based on service PFTs.  The 14 May 2008 VARD rated the asthma at 0% citing the 24 April 2008 VA C&P examination.  The PFTs and absence of medication use 5 months after separation is concordant with the rating of 0% by the VA.  Although the MEB and PEB listed the asthma as EPTS and permanently aggravated by service, there is compelling evidence (after separation and not available to the PEB) that the service-aggravation was not, in fact, permanent.  Upon return to his home of record, and geographical separation from presumed asthma triggers (allergies), the symptoms resolved.  The Board again noted that the CI initially presented with SOB with exertion in the setting of a 25-pound weight gain since his accession physical.  He smoked throughout his evaluation.  The obesity, with the attendant deconditioning, and tobacco abuse at the very least contributed to many of the objective findings and subjective symptoms recorded.  It is also very likely that the geographical location contributed to his symptoms which began after assignment to Texas and resolved after he moved.  The Board notes the above for the record, but the PEB determination that there was permanent service-aggravation is not within the purview of the Board and therefore stands.  The Board then considered the appropriate rating.  The use of daily medications recorded by the PEB supports a rating of 30%; the PFTs supported only a 10% rating.  However, the CI was clearly asymptomatic and had normal PFTs off of medications at an examination 5 months after separation.  This supports a 0% rating.  The totality of evidence supports no more than a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication 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 20140127, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150009588 (PD201400712)

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