RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX CASE NUMBER: PD1201241 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130425 

SEPARATION DATE: 20020430 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SSG/E-6 (71L30/Administrative NCOIC), medically 
separated for exertional shortness of breath (SOB) secondary to reactive airway disease (RAD). 
The CI developed dyspneal exertion while performing Mission Oriented Protective Posture 
(MOPP) training. Despite otolaryngology and pulmonary evaluations, pulmonary function 
testing (PFT), and a Methacholine Challenge Test (MCT), the CI failed to meet the physical 
requirements of her Military Occupational Specialty or satisfy physical fitness standards. She 
was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded exertional SOB secondary to RAD to the Physical Evaluation Board (PEB). The 
MEB forwarded no other conditions for PEB adjudication. The PEB adjudicated the exertional 
SOB secondary to RAD condition as unfitting, rated 10%, with application of the Veterans Affairs 
Schedule for Rating Disabilities (VASRD). The CI made no appeals, and she was medically 
separated. 

 

 

CI CONTENTION: “This condition occurred after surgery to remove a cyst on the right thyroid.” 

 

 

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. The unfitting exertional SOB secondary to 
RAD condition meets the criteria prescribed in DoDI 6040.44 for Board purview and it 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 
Army Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20020125 

VA (~4 Mos. Post-Separation) – All Effective Date 20020501 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Exertional Shortness of 
Breath Secondary to 
Reactive Airway Disease 

6602 

10% 

Obstructive Ventilary 
Disease 

6699-6600 

Not Service 
Connected 
(NSC) 

20020913 

.No Additional MEB/PEB Entries. 

Total Abdominal 
Hysterectomy, Pelvic 
Abscess 

7618 

30% 

20020913 

0% X 2 

20020913 

Combined: 10% 

Combined: 30% 



 

 

ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System fitness determinations and rating decisions for 
disability at the time of separation. The Board utilizes service and VA evidence proximal to 
separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for 


special consideration of post-separation evidence. Post-separation evidence is probative only 
to the extent that it reasonably reflects the disability and fitness implications at the time of 
separation. 

 

Exertional Shortness of Breath Secondary to Reactive Airway Disease Condition. The CI initially 
presented to otolaryngology for a right true vocal cord paralysis. During the workup, it was 
noted that the CI also had exertional dyspnea during MOPP training and needed a referral to 
pulmonary. The CI underwent an exercise study that revealed a decrease in oxygen 
consumption with decreased oxygen saturation to 88%. The CI terminated the study because 
she complained of muscular fatigue and some chest tightness. Because there was not a clear 
reason for the symptoms, a MCT was performed In November 2001 along with a PFT that 
showed a decrease to 67% in the Forced Expiratory Volume (FEV1) after administration of the 
methacholine. In addition, on the flow volume loop there was a consistent and reproducible 
partial obstruction that was suggestive of an obstruction from a combination of some RAD as 
well as a partial obstruction from the vocal cord paralysis. The pre-bronchodilator FEV1/FVC 
was 78% of predicted. The CI was placed on a permanent P3 Profile for obstructive ventilator 
defect with restrictions of no MOPP training with running and walking at her own pace and 
distance. The MEB narrative summary (NARSUM) exam approximately 4 months prior to 
separation indicated chronic SOB and that because the CI had true iatrogenic vocal cord 
paralysis, this made her symptoms significantly worse and prevented her from participating in 
MOPP training and required an alternate physical fitness test. According to the examiner, the 
November PFT MCT “clearly showed a decrease in her FEV1 of 33% from her baseline at 10mg 
per dl” of methacholine. A second PFT was completed in January 2002 and it noted a pre-
bronchodilator FEV1 of 78% of predicted. The examiner opined the CI had exertional SOB due 
to RAD as indicated by the MCT as well as a true iatrogenic vocal cord paralysis that increased 
the severity of her symptoms. The examiner further opined that the CI would not respond to 
chronic use of inhaled steroids. The VA Compensation and Pension (C&P) examination 
approximately 4 months after separation documented SOB with exertion. The examiner noted 
a PFT performed at the VA found that the FEV1, although somewhat diminished, was better 
than the predicted and after bronchodilator use improved even more which caused the 
examiner to opine that the CI did not have any respiratory problem and her symptoms were a 
natural effect from exercise. However, this conclusion is incorrect and no PFT values were 
included so the Board cannot assess this PFT. A person with RAD will show improved values 
after the administration of a bronchodilator and in fact, this is considered diagnostic for RAD. 
Additionally, no MCT was performed by the VA examiner and he made no comment on the 
testing performed by the service. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB coded the exertional SOB secondary to RAD condition as 6602 asthma, bronchial (FEV-1 of 
71- to 80% predicted or FEV-1/FVC of 71 to 80%) and rated 10%. The PEB based their 
determination on the PFT performed in January 2002, which included a pre-bronchodilator 
FEV1/FVC of 78% of predicted. No chronic therapy was indicated. The VA coded the 
obstructive ventilary disease 6699-6600 bronchitis, chronic and determined there was no 
clinically diagnosed obstructive ventilary disease and therefore, it was not service-connected. 
The C&P exam noted a somewhat diminished FEV1 that increased after administration of a 
bronchodilator. However, there was no documentation of any actual assigned FEV1 or 
FEV1/FVC values. Without these values, the Board cannot make a rating determination based 
on this examination. Therefore, the Board determined the MEB NARSUM examination findings 
had greater probative value. 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 exertional SOB secondary to RAD 
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 exertional SOB secondary to RAD condition and IAW 
VASRD §4.96a, 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 recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Exertional Shortness of Breath Secondary to Reactive Airway 
Disease 

6602 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120619, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxxx, DAF 

Director of Operations 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130010764 (PD201201241) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)