RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200671 SEPARATION DATE: 20030430 

BOARD DATE: 20130219 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (31U/Signal Support Systems Specialist), 
medically separated for asthma and chronic lower extremity pain due to bilateral 
patellofemoral syndrome (PFPS) and tibial stress fractures. The CI developed an asthmatic 
condition and unrelated non-traumatic bilateral knee pain in 1997. These conditions could not 
be adequately rehabilitated with treatment to meet the physical requirements of her Military 
Occupational Specialty (MOS). She was issued a permanent P3 and L3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical 
Evaluation Board (PEB) adjudication. The PEB adjudicated the asthma and chronic lower 
extremity pain as unfitting, rated 10% and 10%, with application of the Veteran’s Affairs 
Schedule for Rating Disabilities (VASRD) and the US Army Physical Disability Agency (USAPDA) 
pain policy. The CI made no appeals and was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: “Asthma at the time of the Review Board and while in service I was taking 
more than one corticosteroids. Several ER visits while on Active Duty. And passing out in the 
field during a training mission caused me to have less than 60% oxygen – all asthma related. 
Due to the severity of my knee pain and asthma I was found unfit to run on the PT test. Several 
x-rays and doctor visits indicated such severity of my asthma and the worsening condition of 
my knees. At the time of final reading I was not advised I could do a review of the final findings 
if I disagreed.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. 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 Army Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service FPEB – Dated 20030213 

VA (1 Mo. Pre-Separation) – All Effective Date 20030501 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Asthma 

6602 

10% 

Asthma 

6602 

10% 

STR 

Chronic lower extremity 
pain 

5099-5003 

10% 

Patellofemoral system, rt knee 

5299-5260 

10% 

STR 

 

 

Patellofemoral system, lt knee 

5299-5260 

10% 

STR 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 2 

Combined: 20% 

Combined: 30% 



*No C&P exam was administered until 20050419 


 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the DES considers all of the member's medical conditions, 
compensation can only be offered for those medical conditions that cut short a member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However, the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
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 severity at the time of 
separation. The Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to the CI’s statements in the application regarding suspected DES improprieties in 
the processing of his case. 

 

Asthma. The CI was first treated for reactive airway disease (asthma) in 1997. She had a history 
of childhood asthma, but this had resolved by time of enlistment. The CI was treated with 
bronchodilator inhaler therapy (Albuterol) and intermittent treatment intervals of oral 
inhalational anti-inflammatory medication (AFM). The CI was first begun on daily treatment 
with AIFM (Azmacort four puffs a day) 18 September 2000. On evaluation at the asthma 
center, 23 October 2000, plans were expressed to increase the dose on Azmacort and add other 
medication but, this was not eventuated. By 21 May 2001, the Azmacort had been stopped and 
treatment continued only with inhalers. A year later, on 15 May 2002, on asthma clinic 
evaluation the CI was again under treatment with Azmacort, six puffs per day. Three months 
later, 9 August 2002, the CI was evaluated in the emergency department (ER) for history of 
wheezing. Azmacort had been discontinued with inhalers the only treatment. Chest 
examination was normal and the CI was treated with a short course of outpatient oral steroids. 
Upon return to the ER on 20 September 2002, the CI now reported treatment with a new AFM 
(Flovent). However, on evaluation on 30 September 2002, no current medications were 
recorded. The MEB/narrative summary (NARSUM) exam 2 months before separation, reported 
the CI to be taking Flovent and using an inhaler ‘a couple of times a week’ to control symptoms 
Clinical examination of the chest was normal. Pulmonary function tests (PFTs), obtained 
30 January 2003, revealed evidence of mild asthma. No VA Compensation and Pension (C&P) 
examination was performed. 

 

 The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and VA both rated the asthma condition 10% code 6602, asthma. The PEB cited the PFT 
and use of intermittent inhalational bronchodilator therapy; the VA referenced service 
treatment records (STRs) and findings of the MEB Board examination. Under this code a rating 
of 10% requires FEV1 of 71% to 80% predicted or FEV1/FVC of 71 to 80% or intermittent 
inhalational or oral bronchi-dilator therapy. A higher rating of 30% requires FEV1 of 56 % to 
70%, or FEV1/FVC of 56% to 70% or daily use of bronchodilator therapy; or inhalational anti-
inflammatory medication. The Board unanimously agreed that a higher rating could not be 
achieved using PFT. The Board noted the CI to be treated intermittently with inhalational anti- 
inflammatory medications and undertook to ascertain if this supported a higher rating. The 
Board unanimously agreed that statements by the NARSUM, STRs and the medication profiles, 


confirmed with reasonable certainty the CI to be under treatment with inhaled anti-
inflammatory medication at the time of separation and that the 30% rating was applicable. A 
higher rating of 60%, requiring intermittent courses of systemic steroids of at least three per 
year, was not supported by the record in evidence. 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. 

Chronic lower extremity pain. The CI developed bilateral lower leg pain in February 1997 
without history of specific trauma. Bone scan obtained 28 April 1997 revealed a small stress 
fracture in the left mid lower leg. On physical therapy evaluation 24 August 2000, no evidence 
of knee instability was noted bilaterally. Repeat bone scan, 4 January 2001, documented a 
small stress fracture in the mid-shaft of the left lower leg which subsequently healed. The CI 
successfully completed physical therapy (PT) tests with alternative two mile walk on 18 June 
2002, 10 months prior to separation and 13 November 2002, 5 months prior to separation, with 
outstanding scores without difficulty. At the MEB/NARSUM evaluation 14 January 2003, 2 
months before separation, the CI reported her knee pains to be slight but frequent in nature. 
On physical examination, range-of-motion (ROM) of both knees was normal without pain, 
effusion, swelling or ligamentous laxity. Some crepitus without pain was noted bilaterally. 
Motor and sensory examinations were normal. Mild tenderness to deep palpation was present 
in both mid lower legs without swelling, bony abnormality or deformity. No C&P evaluation 
was performed. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the bilateral leg condition 10% code 5003. The VA, using the STR and MEB 
examination, rated the right and left knee conditions separately at 10% each, code 5260, 
limitation of flexion. The Board noted the PEB to bundle the leg conditions. Not uncommonly 
this approach by the PEB reflected its judgment that the constellation of conditions was 
unfitting, and there was no need for separate fitness adjudications or implied adjudication that 
each condition was separately unfitting. The Board’s initial charge in this case was, therefore, 
directed at determining if the PEB’s approach of combining conditions under a single rating was 
justified in lieu of separate ratings. The Board must apply separate codes and ratings in its 
recommendations if compensable ratings for each condition are achieved IAW VASRD §4.71a. 
If the Board judges that two or more separate ratings are warranted in such cases, however, it 
must satisfy the requirement that each ‘unbundled’ condition was unfitting per se. Thus, the 
Board must maintain the prerogative of separate fitness recommendations in this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB. The Board opined that both lower leg conditions were mild and 
was unable to ascertain if one leg was consistently more symptomatic than the other. The 
Board noted successful completion of PT tests 5-10 months prior to separation without 
difficulty, and the commander’s statement noting the limitations of profile to mainly involve 
the unfitting asthma condition, with no specific tasks impeded by knees except squatting. The 
Board noted the profile, to allow marching two miles, wearing back pack, carrying weapon, 
mowing grass and walking, swimming and bicycling. After due deliberation, the Board agreed 
that the predominance of evidence does not support a conclusion that either knee, as an 
isolated condition, would have rendered the CI incapable of continued service within her MOS. 
The Board concluded that neither was unfitting and, accordingly, could not recommend a 
separate service rating for either. 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 lower extremity pain 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 the USAPDA pain policy for rating leg condition was operant in this case and the 
condition was adjudicated independently of that policy by the Board. In the matter of the 
asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6202, 
IAW VASRD §4.87. In the matter of the lower leg condition and IAW VASRD §4.71a, 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 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% 

Chronic lower extremity pain 

5099-5003 

10% 

COMBINED 

40% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120814, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


 

SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-
3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXX, AR20130005094 (PD201200671) 

 

 

1. 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 reject the Board’s recommendation and hereby deny the individual’s application. 
There is insufficient justification to support the Board’s recommendation in accordance 
with Army and Department of Defense regulations. 

 

2. The Board’s recommendation to increase the rating for asthma from 10% to 30% is 
not supported by the record. The Board determined that the individual was under 
treatment with inhaled anti-inflammatory medication at the time of separation and that 
the 30% rating was justified. The pharmacologic record and the NARSUM do not 
support any regular use of such medication. Although the Medical Evaluation Board 
(MEB) Narrative Summary appears to be somewhat contradictory regarding use of 
medications, it concludes by saying that “Her asthma requires weekly use of rescue 
medicines and frequent use of oral steroids.” The pharmacy record shows the last 
prescription for inhalational anti-inflammatory medication was given in January 2003, 
the month of the MEB, and prior to that a one month supply (without refills) was 
prescribed in June 2002. 

 

3. Because the Service Treatment Record was somewhat vague regarding a need for 
inhalational steroid management, the Veterans Affairs (VA) record was examined. The 
VA originally assigned a 10% rating using the same records that were available to the 
Physical Evaluation Board (PEB). Additionally, in 2005, the VA reassessed the 
individual’s rating for asthma. They concluded that current medical records showed no 
treatment for asthma. They noted that the individual claimed to suffer an attack every 2 
to 3 months and that an Albuterol inhaler was used on an as needed basis. The VA 
concluded that a 10% rating remained appropriate. Although the goal is to determine 
the extent of disability at the time of separation, post separation records can sometimes 
shed light on the accuracy and fairness of the original disability determination. 

 


4. The preponderance of the evidence supports the conclusions reached by the PEB 
and VA. The PDBR has not adequately refuted those determinations. 

 

5. 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 

 (Army Review Boards)