RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00754
BRANCH OF SERVICE:  Army	BOARD DATE:  20140910
SEPARATION DATE:  20060707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (42A2O/Human Resources Specialist) medically separated for asthma that first presented as dyspnea on exertion.  This condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  The CI was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The Asthma (moderate persistent) condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the asthma condition as unfitting, rated at 10%, with 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 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 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.  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 Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20060316 | VA* - (1.9 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma | 6602 | 10% | Asthma | 6602 | 10% | 20060512
Other x 0 (Not in Scope) | Other x 4 (Not in Scope) | 20060512
Combined:  10% | Combined:  20%
*Derived from VA Rating Decision (VARD) dated 20070110 (most proximate to date of separation)

ANALYSIS SUMMARY:

Asthma Condition.  The CI developed shortness of breath (SOB) and dyspnea on exertion (DOE) during basic training in 2002.  Initial pulmonary function tests (PFT) suggested an asthma condition.  The methacholine provocation test performed on 2 December 2002, confirmed the diagnosis of asthma.  The CI was treated with daily inhaled steroids and bronchodilators (albuterol) as needed for rescue.  PFT obtained on 2 May 2005 revealed FEV-1 of 106% and FEV-1/FVC (RATIO) of 74% after bronchodilitation (ABD).  On multiple clinic visits from March through August 2005, the CI was treated with different combinations and doses of inhaled steroid as well as oral and inhaled bronchodilators.  A repeat partial PFT obtained on 9 February revealed FEV-1 of 75% (ABD).  At the MEB Medical Examinations (SF 2807/2808) dated 16 and 23 February 2006, respectively (approximately 5 months prior to separation), the CI reported taking inhaled steroids and oral bronchodilators for the asthma condition.  At the MEB narrative summary (NARSUM) evaluation performed on 17 February 2006 (approximately 5 months prior to separation), the CI reported her asthma symptoms to be triggered by exercise, cold air and seasonal allergies.  Medications were reported as inhaled steroids and bronchodilators.  The examiner opined that the CI “over the last 9 months has had good compliance with her medical treatment”.  On physical examination the lungs were normal.  A routine chest X-ray dated 3 October 2005 was referenced as normal.  The NARSUM attached a medication profile for the CI for the period 21 January 2005 to 1 February 2006, to its report to the PEB.  At the VA Compensation and Pension (C&P) dated 12 May 2006 (2 months before separation), the CI was reported to be taking oral steroids and bronchodilators and her condition to be stable.  Physical exam of the chest was normal.  A chest X-ray dated 21 February 2006 was also referenced as normal.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated asthma condition at 10% under code 6602 (asthma-bronchial), IAW §4.97; the PEB citing intermittent use of medication based on the medication profile of the NARSUM and the VA, citing the PFT ratio of 74% from service treatment records (STR) evaluation of 2 May 2005.  Under code 6602, a rating of 10% requires, FEV-1 of 71 to 80% predicted or; a ratio of 71 to 80 percent on PFT; or intermittent inhalational or oral bronchodilator therapy.  A higher code of 30% requires FEV-1 of 56 to 70% predicted or ratio of 56 to 70 percent; or daily treatment with inhalational or oral bronchodilator, or inhalational anti-inflammatory medications.  A 60% rating requires FEV-1 of 40 to 55%, or Ratio of 40 to 55%, or at least three courses of parenteral (IV or IM) or oral corticosteroids in a 1-year period in treatment of the asthma condition.  The Board unanimously agreed the asthma condition could be rated no higher than 10% using PFT criteria.  The Board next determined if a higher rating was indicated for medication use.  The Board noted the preponderance of evidence in record, to include the DES and VA examinations, suggested the CI to be under treatment with inhaled steroid medication at time of separation.  The Board closely scrutinized the medication profile in record and concluded, after intense analysis that the dates of prescription filling and medication refill data for inhaled steroids and oral bronchodilators, supported, with reasonable certainty, that these medications were filled regularly for the CI in the period January 2005 to February 2006.  The Board unanimously agreed that these data support the criteria for a rating of 30%.  The Board next undertook to ascertain if a higher rating of 60% was indicated.  The Board was unable to recommend this rating as the CI received oral corticosteroids on only two occasions in the year prior to separation.  The Board found no other appropriate codes for consideration.  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 recharacterized to reflect permanent disability retirement, effective as of the date of her 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 20140206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

					
XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150006651 (PD201400754)

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

PD-2014-00754