RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01773
BRANCH OF SERVICE:  Army	BOARD DATE:  20141125
SEPARATION DATE:  20050824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (21J/Construction Equipment Operator) medically separated for exercise-induced asthma.  The asthma condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty.  However, his profile indicated he could take an alternate physical training test.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “exercise-induced asthma,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “exercise induced asthma” as unfitting, rated at 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 20050706 | VA – (16½ mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Exercise-induced Asthma | 6602 | 10% | Reactive Airway Disease | 6699-6602 | 10% | 20070104
Other x 0 (Not in Scope) | Other x 4 | 20060502
Combined:  10% | Combined:  20%
        Derived from VA Rating Decision (VARD) dated 20070221 (most proximate to date of separation)

ANALYSIS SUMMARY:

Asthma.  In July 2004, this CI sought medical attention for difficulty breathing.  He was diagnosed with upper respiratory infection and treated with an inhaled bronchodilator.  Over the next several months, he continued to have breathing difficulties. In December 2004, pulmonary function tests (PFTs) showed a minimal obstructive lung defect.  On the basis of that study, more detailed pulmonary function testing was recommended.  In February 2005, he had a Methacholine challenge test (MCT) which was positive for hyper-reactivity.  Repeat MCT was performed in April 2005, and it too showed airway hyper-reactivity to Methacholine.

The CI was diagnosed with reactive airway disease.  He was issued a P3 profile, and MEB was initiated.  The MEB narrative summary was dated 16 June 2005.  At that time, the CI reported a history of exercise-induced breathing difficulties.  He said, “I even have shortness of breath when I am cleaning my house, and I am required to take breaks and use the inhaler.”  There was no history of asthma-related hospitalization, steroid usage or emergency room visits.  He denied any symptoms, such as wheezing or coughing, at rest.  His medications were Albuterol (short-acting inhaled bronchodilator), Percocet (narcotic for pain) and Claritin (antihistamine for allergies).  Physical examination (PE) of the chest revealed normal respiratory effort and normal breath sounds.  The lungs were clear to auscultation, with no wheezes, rales or rhonchi.  The examiner diagnosed exercise-induced asthma.  PFTs were not done at the June 2005 MEB exam.

As noted above, the CI was separated from service in August 2005.  About 16 months later on 4 January 2007, he had a VA Compensation and Pension (C&P) exam.  He reported that his symptoms were intermittent, with remissions.  He was using his inhaled bronchodilator on an intermittent basis.  Acute asthma attacks were occurring about one or two times per year.  Once again, he denied any history of dyspnea (difficulty breathing) at rest. PE revealed a respiratory rate of 16 breaths per minute (normal).  Examination of the chest and lungs was normal.  PFTs were done.  The forced expiratory volume in the first second (FEV-1) was 3.74 liters (73.5% of predicted).  The FEV-1 divided by forced vital capacity (FVC) was 65.5%.  The CI’s PFT results are summarized in the chart below.

PFTs

PFT Lab ~ 8 mos. Pre-Sep 
(20041215)

VA C&P ~ 16½ mos. Post-Sep
(20070104)

FEV-1 (% of Predicted)

94% pre-drug,
94% post-drug

73.5%

FEV-1/FVC

76% pre-drug,
76% post-drug

65.5%

Medications | intermittent use of inhaled bronchodilator | intermittent use of inhaled bronchodilator
§4.97 Rating | 10% | 30%

The Board directed attention to its rating recommendation based on the evidence above.  Both the Army PEB and the VA assigned a 10% disability rating.  In the VASRD §4.97, the rating guidance for asthma is based on clinical exacerbations, type & frequency of medications used and results of PFTs.  For the reader’s convenience, the VASRD §4.97 languages for the 10% and 30% ratings (diagnostic code 6602) are excerpted below:

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 .....................................................30 

FEV-1 of 71 to 80-percent predicted, or; FEV-1/FVC of 71 to 80 
percent, or; intermittent inhalational or oral bronchodilator therapy .................10

The Board carefully reviewed all evidentiary information available and noted that the January 2007 C&P exam was done 17 months after separation.  The Board can use VA evidence proximate to separation in arriving at its recommendations. DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, resides in evaluating the fairness of PEB fitness determinations and rating decisions for disability at the time of separation.  Post-separation evidence is probative only to the extent that it reasonably reflects the disability and fitness implications at the DOS.  The Board determined that the January 2007 C&P exam was too long after separation, and therefore had diminished probative value.
The pre-separation clinical data in the treatment record was closer to date of separation and therefore had greater probative value.  In December 2004 (8 months prior to separation), PFTs showed a minimal obstructive lung defect.  The FEV-1 divided by FVC was 76%.  At the June 2005 MEB visit, the CI was intermittently using an inhaled bronchodilator.  There was insufficient evidence of daily use and insufficient evidence of anti-inflammatory medication.  The Board determined that, based upon the evidence, a disability rating of 10% was appropriate at the time of separation.  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.  It is appropriately coded 6602 and IAW VASRD §4.97, meets criteria for the 10% rating level.

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 Exercise-induced asthma 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 20140422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008240 (PD201401773)

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

PD-2014-01773