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AF | PDBR | CY2012 | PD2012 01210
Original file (PD2012 01210.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201210
BRANCH OF SERVICE: Army  BOARD DATE: 20130619
DATE OF PLACEMENT ON TDRL: 20020805
Date of Permanent SEPARATION: 20031202


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty S S G/E- 6 ( 68X30/AH-64 Armament and Electric Repairman ) medically separated for asthma with vocal cord dysfunction (VCD) and l eft knee pain. The CI suffered a knee injury in 1 996 while working on a truck. He subsequently underwent left knee anterior cruciate ligament (ACL) reconstruction and thereafter was diagnosed with patellofemoral pain syndrome. The CI sought care for “attacks” of chest tightness, shortness of breath (SOB) and wheezing which he felt were in h is upper airways near his neck that came on during exercise, stressful situations, and occasionally at rest. He had a trial of multiple asthma medications and was subsequently diagnosed with a sthma with VCD . Neither condition could be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 / L3 profile, and referred for a Medical Evaluation Board (MEB). The asthma with VCD and left knee conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 . No other conditions were submitted by the MEB. The PEB adjudicated asthma with VCD and chronic pain left knee conditions as unfitting, rated 30 % and 0 % respectively , referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI was placed on Temporary Disability Retired List (TDRL) with ratings as reflected in the chart below. At the reevaluation approximately a year later, the PEB adjudicated the left knee condition as unfitting, and increased the rating to 10% . The asthma with VCD condition was also adjudicated as unfitting, but was reduced to 10%. T he USAPDA reviewed the case as the CI non - concurred with the PEB ’s decision ; however, the USAPDA u ph e ld the PEB’s decision. The CI was then medically separated .


CI CONTENTION: “Yes my Back. I had an accident in the field. My back accident was on duty. I was put on prement profile I was told to attend back classes. I have submitted proff of my back pain while in the Army and VA is paying for it. I also have attached paperwork showing
The Army said I had degeneratic disc and a disc bulge and Chronic low Back pain. When I got my paperwork from the Army it said I was given 30% and chronic low back was on there so I signed it and sent it back. But after 2 or 3 months later the Army left my back pain claim out and gave me 20%. VA is give me 10% for back pain. I even had surgery in Feb for my back Va did the operation in NC. I had sleep apnea. My wife and I had to seek outside help. We had to get a CPAP machine which I am still using.”


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 ratings for the unfitting asthma with VCD and left knee conditions are addressed below. The requested lower back was identified by the final PEB and therefore is within the DoDI 6040.44 defined purview of the Board and is addressed below. The sleep apnea condition however was not identified by either the first or final PEB, and thus is not within 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.

The Board acknowledges the CI’s opinion that an administrative error was responsible for his combined permanent disability of 20%. It must be noted for the record that the Board has neither the jurisdiction nor authority to scrutinize or render opinions in reference to allegations regarding suspected improprieties. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB disability ratings and fitness determinations as elaborated above. Redress in excess of the Board’s scope of recommendations must be addressed by the BCMR and/or the United States judiciary system.


RATING COMPARISON:

Final Service Admin Corrected IPEB – 20031125
VA (~18 Mo. Prior to Permanent Separation)
Effective 20020908
On TDRL - 20020508
 Code Rating Condition Code Rating Exam
Condition
 TDRL Sep.
Asthma, with Vocal Cord Dysfunction
6602 3 0% 1 0% Asthma with Vocal Cord Dysfunction 6602 30% 200 20606
Chronic Pain, Left Knee
5099-5003 0% 10% Degenerative Joint Disease, Left Knee 5010 10% 20020606
Scarring, Left Knee 7805 0% 20020606
Lumbar Degenerative Disc Disease
 Not Unfitting Degenerative Joint Disease, Lumbar Spine w/L Radiculopathy 5295-5010 0% 20020606
No Additional MEB/PEB Entries.
 Other x 4 20020606
Combined: 30% → 20%
 Combined: 40%


ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that his combined VA rating of 40% differs considerably from the 20% combined permanent rating conferred by the USAPDA, but must emphasize that the Board’s recommendations are confined to those conditions determined to be unfitting at the time of the CI’s placement on TDRL. Unlike the VA which provides compensation for all service-connected conditions, the Disability Evaluation System (DES) (and by extension the Board) provides compensation only for those conditions determined to render the member incapable of further military duty. The Board may review the appropriateness of the PEB’s fitness adjudications for all conditions at the onset of TDRL, but does not have the prerogative of recommending a rating for conditions which did not become unfitting until after that point. It should be noted, however, that conditions determined to be unfitting at the time of temporary retirement are subject to a change in that determination (i.e., no longer unfitting) at the time of permanent separation. In cases encompassing a period of TDRL, although the Board’s review of fitness adjudications is relevant to the time of temporary retirement, the Board’s rating recommendations are based on severity evidenced at the time of permanent separation.

The Board also acknowledges that the CI sought treatment from the VA for the asthma with VCD from 5 August 2002 forward. These treatment records, up to a year after the CI’s date of separation, while referenced, were not available in the evidence before it, and could not be located after the appropriate inquiries. The missing evidence will be referenced below in relevant context.

Asthma, with Vocal Cord Dysfunction Condition. The CI sought care for “attacks” which consisted of symptoms of wheezing, chest tightness, SOB, and nocturnal cough. He also had a history of allergies. After being evaluated with multiple pulmonary function tests (PFTs), a Methacholine challenge test to assess exercise induced asthma, and an exercise study, he was diagnosed with asthma and VCD. The exercise study, in particular, revealed significant changes in the FEV1 which had decreased from 71% baseline to 59%. There was a noted truncation of his inspiratory volume loop which led to a direct laryngoscopy (procedure to view vocal cords) that revealed adduction (closing) of his vocal cords with deep inspiration and speaking. After 5 minutes of relaxing, the CI became normal and asymptomatic. He was given Albuterol and had significant improvement of his FEV1 by 24%.

At the time of his MEB he had not required any oral steroids, had not been intubated, and was doing well. Pulmonary and speech pathology were actively following him. He was daily taking the medications Advair (an inhaled combined steriod/beta agonist for asthma) and Singulair (a leukotriene for allergies or asthma), and Albuterol (an inhaled beta-agonist for asthma) as necessary. He was still having 1-2 attacks per week and noted relief with breathing techniques and Albuterol use. The narrative summary (NARSUM) exam demonstrated faint expiratory wheezing in the lung bases. He was not able to do a physical fitness test due to this condition which was identified on his permanent profile, and additionally the profile documented “severe reactive airway disease-no field duty.”

At the VA Compensation and Pension (C&P) exam performed 18 months prior to permanent separation, the CI additionally reported having symptoms of SOB with walking two to three city blocks, and at rest and that he sought care twice a month for this condition. The C&P exam demonstrated a normal lung exam and the addendum documented PFT’s completed in the office which were consistent with asthma yet specific numeric figures were not in evidence.

At the TDRL reevaluation exam a years later and approximately 4 months prior to separation the CI was receiving care through the VA primary care clinics. These records were not available for review. He reported his condition was overall stable on the current inhaler regimen of daily Advair, daily Singulair, and daily use of the Albuterol. He reported the symptoms that required treatment were primarily episodic SOB, without significant wheezing. The CI had been to the urgent care 2-3 times in the last year, and did not report any recent oral steroid use. The TDRL exam demonstrated a normal pulse oximetry (oxygen level) and a normal lung exam. Chest X-ray was normal. The examiner diagnosed asthma, moderate persistent, with VCD. The medication profile from December 2002 through July 2003 documented one prescription for the oral steriod, Prednisone 50 mg of which 5 tablets were dispensed with no refills and an Albuterol prescription for 17 inhalers of which there was 3 of 3 refills remaining.

There were two pulmonary exam evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below:

Pulmonary Exam
 MEB ~ 24 Mo. Pre-Sep
 Post Bronch		 VA ~ 18 Mo. Pre-Sep TDRL ~4.5 Mo. Pre-Sep
Post Bronch
FEV1 (% Predicted)
 77% 71%
FEV1/FVC
 77%
Meds
 Advair, Singulair, Albuterol PFT’s consistent with asthma,
Advair, Albuterol , Singulair 		Advair, Singulair, Albuterol
§ 4.97 Rating
 10%*vs. 30% ** 30% ** 10%* vs. 30% **
*Based on PFT criteria alone
 **Based on daily inhalational medications
The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA applied the same Veterans Affairs Schedule for Rating Disabilities (VASRD) code 6602 (asthma, bronchial) and were subject to the same rating criteria IAW §4.97—schedule of ratings–respiratory system. For the reader’s convenience, the VASRD §4.97 language is excerpted below:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than
40 percent, or; more than one attack per week with episodes of
respiratory failure, or; requires daily use of systemic (oral or
parenteral) high dose corticosteroids or immuno-suppressive
medications .......................................................................................................100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; at least monthly visits to a physician for required
care of exacerbations, or; intermittent (at least three per year)
courses of systemic (oral or parenteral) corticosteroids ......................................60

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 also considered VASRD §4.96 which specifies when evaluating based on PFTs, use post-bronchodilator results in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results.

All members readily agreed that the PFT in the MEB and the TDRL exam are post-bronchodilator measurements as specified by §4.96 and further acknowledges the exams were above 70% therefore a rating higher than 10% could not be achieved by the PFT criteria alone. There is no evidence for respiratory failure, frequent exacerbations requiring physician intervention, daily use of high dose corticosteroids or immune-suppressive medications, or frequent use of systemic corticosteroids. Therefore the higher 60% or 100% ratings IAW 6602 criteria are not supported.

The treatment criteria underpinning the 10% and 30% ratings are the pivotal points for the decision in this case. The 10% rating requires “intermittent inhalational or oral bronchodilator therapy;” the 30% rating requires “daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.” The PEB assigned a 30% rating on entry onto TDRL due to the evidence reflecting daily inhalation use. The PEB assigned a 10% rating on permanent separation, in spite of the evidence not reflecting a change in therapy from entry, or a change in diagnosis. The PEB relied on the only medication profile in evidence that was close to separation which the PEB judged did not reflect medication quantities compatible with daily inhalational medication therapy. The VA assigned a 30% rating after entry onto TDRL for daily inhalation medication use and did not change this rating in future rating decisions. The VA generally concedes the 30% rating if there is a prescription for any of these agents, and the Board’s precedent has been to follow suit, even though it is clear that this encompasses many cases of well-controlled disease associated with minimal limitations and disability. The Board however does take the reasonable position that the evidence in such cases should satisfy an assumption that the treatment regimen supporting the higher rating is necessary to maintain good control of the condition. That question is only raised in cases where there is evidence that the condition is well controlled in spite of documented non-compliance or only sporadic use of the medications in question. It was debated as to whether it was satisfactorily established in this case that the CI, although clearly prescribed treatments meeting the 30% criteria, actually required the daily regimen to defend the good control evidenced by the PFT results or symptom control. The medical member discussed the CI’s diagnosis of moderate persistent asthma alone meets the requirement for daily inhalational anti-inflammatory medication which is the first line treatment for this condition. In addition, the CI had a VCD that significantly responded to the beta-agonist inhalational medication, Albuterol for which the medication profile in evidence reflects dosing consistent with daily inhalational use. It was the persistence of symptoms and the inability to exercise due to both his asthma and VCD that prompted his MEB and separation from service. However, the Board majority judged the objective medication profile evidence before them did not reflect daily use of inhalational therapy for either an anti-inflammatory or a beta-agonist and notes the CI deployed as a GS civilian to Iraq in 2009 doing the same duties while he was on active duty. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma with VCD condition.

Left Knee Condition. The CI suffered a traumatic injury to his left knee when a trailer fell across his left lower extremity in 1997 while serving in Korea. He underwent a left ACL bone tendon bone reconstruction. He had no postoperative complications and progressed with physical therapy to regain his motion and strength. The permanent profile identified the left knee condition but additionally identified a low back pain (LBP) condition as a L3. The profile allowed for a bicycle physical fitness testing, a requirement of 6.2 miles, which was inconsistent with the CI’s symptoms which began at 4 miles. The other limitations, unable to lift greater than 20 pounds, could be due to either L3 conditions and it would be mere speculation to determine for which it was.

At the time of the MEB he reported aches and pains of his knee with no symptoms of instability. He also reported swelling with running a mile, repetitive crawling or biking more than 4 miles. The NARSUM exam for the MEB demonstrated no swelling of the knee, no joint line tenderness, positive patella grind which reproduced his symptoms, well healed anterior scar and no ligament laxity of the ACL with provocative testing. The X-rays revealed well-positioned hardware in bone plug sites. The examiner diagnosed satisfactory ACL reconstruction, nonsymptomatic.

At the C&P exam performed 18 months prior to permanent separation, the CI reported constant, horrible symptoms of pain, weakness, stiffness, swelling, inflammation, locking, fatigue, and lack of endurance. He reported flare-ups with over usage and that pain medications gave relief. The C&P exam additionally demonstrated negative provocative meniscal testing and an area of numbness involving the left knee. X-ray of the left knee demonstrated changes consistent with ACL repair and early degenerative joint disease. The examiner diagnosed status post ACL repair and degenerative joint disease (DJD) of the left knee.

At the TDRL reevaluation exam a year later and approximately 4 months prior to separation the CI reported chronic anterior knee pain which had been diagnosed as patellofemoral knee pain, residual quad weakness, and numbness along the incision. He reported that his left knee had been stable and he had no symptoms of instability or giving way. The TDRL exam was unchanged from the MEB exam. The X-ray revealed postoperative changes consistent with ACL reconstruction, hardware well-placed without signs of loosening, and no degenerative changes noted.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
 (Degrees)

MEB ~ 24 Mo. Pre-Sep		 VA C&P ~ 18 Mo. Pre-Sep TDRL ~ 4 Mo. Pre-Sep
Flexion (140 Normal)
 120 120 120
Extension (0 Normal)
 0 0
Comment
 1 degree of hyperextension, silent to painful motion Painful motion Silent to painful moti o n
§4.71a Rating
 0 % * 10% 0 %
*With application of §4.59 (painful motion)

The Board directs attention to its rating recommendation based on the above evidence. This rating includes consideration of functional loss lAW VASRD §4.40 (functional loss), and §4.59 (painful motion). The PEB and VA chose different coding options for the condition which did not bear on the rating and both rated IAW §4.71a— s chedule of ratings–musculoskeletal system. The PEB ’s DA Form 199 reflected application of the USAPDA pain policy for rating and assigned 0% rating at the time of TDRL placement and 10% at permanent separation for slight/occasional coded 5003 (arthritis, degenerative) . Clearly there is no change in the subjective or objective evidence between these exams yet the PEB is inconsistent with assigning a rating , likely a reflection of the use of the pain policy and that the 30% rating for the asthma allowed placement onto TDRL . The VA assigned a 10% rating coded 5010 (traumatic arthritis) which defaults to the PEB’s chosen 5003 code for painful non-compensable limitation of ROM and additionally for X-ray findings of degenerative changes which is consistent with §4.71a . A 20% rating under this code is assigned in the absence of limitation of motion with occasional incapacitating exacerbations. The evidence does not support incapacitating episodes for this higher rating. There is no evidence of instability to consider application of dual ratings. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was in sufficient cause to recommend a change in the PEB TDRL entry adjudication of 0% or the PEB permanent rating of 10% for the left knee condition .

Contended PEB Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the LBP was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. While the LBP condition was profiled as a P4/L4 condition in May 1992, it was not implicated in the commander’s statement and was not addressed by the original MEB. It was considered in the TDRL re-examination and adjudicated as not unfitting. After May 1992 the evidence does not reflect a MOS Medical Review Board/re-class and therefore the Board members acknowledge the CI continued to work in his primary MOS in spite of his P4/L4 profile. Furthermore the VA at the time of entry onto TDRL assigned a 0% rating of the DJD lumbar spine with left radiculopathy for full ROM. Future rating decisions remained unchanged until 2011, well outside the 24 months for consideration for the Board. Finally the Board notes again, the CI deployed as a GS civilian to Iraq in 2009 as an aircraft mechanic doing the same job he did while on active duty. All was reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the LBP contended condition and so no additional disability rating is recommended.



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. As discussed above, PEB reliance on the USAPDA pain policy for rating asthma, knee, and low back conditions was operant in this case and the conditions were adjudicated independently of that policy by the Board. In the matter of the asthma condition and IAW VASRD §4.71a, the Board by a vote of 2:1 recommends no change in the PEB adjudication. The single voter for dissent (who recommended adopting the VA rating 6602 at 30 %) submitted the appended minority opinion. In the matter of the left knee condition and IAW VASRD §4.71a, the Board by a vote of 2:1 recommends no change in the PEB adjudication. The single voter for dissent (who recommended adopting the VA rating at 10% for TDRL entry) submitted the appended minority opinion. In the matter of the contended low back pain condition, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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
TDRL PERMANENT
Asthma with Vocal Cord Dysfunction
 6602 30% 10%
Degenerative Joint Disease, Left Knee
 5010 0% 10%
Low Back Pain
 Not unfitting
COMBINED
 30% 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120618, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




Physical Disability Board of Review


MINORITY OPINION:

It is reiterated that the PEB’s DA Form 199 reflected application of the USAPDA pain policy for rating and the conditions discussed below were adjudicated independently of that policy by the Board.

The Board was in agreement with the general principle well expressed in these proceedings, i.e., that the 30% rating for asthma (when justified by treatment, not PFT criteria) should be based on the requirement for, not prescription for, the rated treatment criteria. There are three convincing objective references that underpin that the CI required daily inhalational asthma medication. The first and most convincing is the pharmacy record which demonstrates the CI was dependent, at the very minimum, on the daily inhalational of Albuterol. The medication profile documents a prescription for 17 inhalers with 3 refills. From simple math alone this is 51 inhalers. Each inhaler has 200 metered doses which can allow up to 6 doses a day in a month’s timeframe. The evidence reflects the CI was instructed to use two doses as necessary for symptoms. Logically then 17 inhalers would last him a year with daily use. Next, the CI had a significant VCD whereby the evidence reflects a significant FEV1 improvement by 24% with the use of inhalation Albuterol. The CI not only required inhalational Albuterol for his asthma but in addition for his VCD which is likely the reason he received a prescription for an excess number of Albuterol inhalers to be dispensed each time in the opinion of the medical member. Finally, the CI was diagnosed with moderate persistent asthma which is clearly evidenced in the treatment records. The first-line treatment for this diagnosis is daily anti-inflammatory inhaled asthma medication. The service treatment record reflects the CI was tried on several anti-inflammatory medications, (Asmacort, Flovent) before settling on the daily Advair prescription. The examiners in the TDRL placement exam, the VA exam, and the TDRL exit exam all document the CI using daily Advair and his condition was stable on his current regimen. Logically it follows if the CI meets the 30% asthma rating for placement onto TDRL and his treatment regimen has not changed, his diagnosis of moderate persistent asthma has not changed and he is stable then therefore he requires/required daily anti-inflammatory asthma medication. While the minority opinion recognizes the CI did go on to deploy as a civilian doing his same duties, this does not overcome the fact he was separated from service for moderate persistent asthma with a significant vocal cord which required daily inhalational asthma medication. With the consideration of the above stated conclusions, I respectfully submit that a fair recommendation for the asthma rating in this case is 30% at the time of entry onto TDRL and 30% for permanent separation.

With regards to the left knee condition, the evidence is clear again there is no change in the TDRL placement exam and the TDRL exit exam. The PEB assigned a 0% on entry to TDRL yet then increased the rating to a 10% despite a lack in change in the ratable data of the left knee. This reflects an inconsistency by the PEB, likely a reflection of the use of the pain policy. When carefully examining the ratable data, there is a non-compensable loss of knee flexion, X-ray findings of degenerative arthritis after having surgery for the anterior cruciate ligament of the left knee. IAW VASRD code 5003 (arthritis, degenerative) or the VA’s chosen code 5010, it specifies that, in the presence of degenerative arthritis established by X-ray findings, when “the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10% is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.” Both the TDLR entry and TDRL exit exam are silent to painful motion. The VA exam interim exam documents painful motion. The minority opinion considered VASRD §4.7 (higher of two evaluations) which directs the evaluator to assign the higher of two valid ratings if the disability picture more nearly approximates the criteria and respectfully submits that a fair recommendation for the left knee condition rating in this case is 10% onto TDRL and 10% for permanent separation.
In Summary, I respectfully submit that the Secretary considers the minority recommendation 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 his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Asthma with Vocal Cord Dysfunction
 6602 30% 30%
Degenerative Joint Disease, Left Knee
 5099-5003 10% 10%
Low Back Pain
 Not unfitting
COMBINED
 40% 40%


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130018500 (PD201201210)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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  • AF | PDBR | CY2012 | PD2012 01083

    Original file (PD2012 01083.rtf) Auto-classification: Denied

    He was issued a permanent P3 profile andreferred for a Medical Evaluation Board (MEB).Asthma and mild restrictive pattern were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.The PEB adjudicated the asthma and mild restrictive pattern as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals, and was medically separated with a 10% disability rating. a month prior to the PEB,...