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AF | PDBR | CY2012 | PD2012 01240
Original file (PD2012 01240.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201240
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130529
SEPARATION DATE: 20031130


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (0151/Administrative Clerk) medically separated for asthma. The CI had symptoms of exercise-induced asthma since 2001 which prevented him only from keeping up with his company on unit runs. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). Asthma and pulmonary histoplasmosis were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated the asthma condition as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be C ategory III, a condition that is not separately unfitting and did not contribute to the unfitting condition. The CI made no appeals, and was medically separated.


CI CONTENTION: “Asthma/PFB”


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. The CI’s contended pseudofolliculitis barbae condition was not mentioned by the PEB and is therefore not within the purview of the board. The pulmonary histoplasmosis condition was not contended by the CI and is therefore not within the Board’s scope of review. 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 Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20030923
 VA - (9 Years Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma
 6602 10% Asthma 6602 30% 20121226
Pulmonary Histoplasmosis
 CAT III No VA Entry
No Additional MEB/PEB Entries
 Other x 2 20121226
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20130125 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him. The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates. 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. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws (Title 38, United States Code). The Board evaluates DVA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation.

Asthma Condition. The CI had a history of exercised-induced asthma with running since June 2001 manifested by shortness of breath (SOB), wheezing, and chest discomfort. He reported mild, subjective improvement with an inhaled bronchodilator, which was objectively corroborated by pulmonary function testing (PFT). His primary physician noted that the CI had to use an inhaled bronchodilator before, during and after running; and that his condition had improved based on running times but had not returned to baseline. A review of the service treatment record (STR) between August 2001 and the time of separation revealed no visits for acute SOB, no abnormal lung exams or pulse oximetry values, and no treatment involving parenteral steroids. At a cardiac stress test on 27 March 2003 (8 months prior to separation) the CI completed 15 minutes of exercise and achieved 17.20 metabolic equivalents (indicating a high level of fitness). The test was terminated because the target heart rate was reached. SOB was not reported. The narrative summary (NARSUM) on 27 March 2003 noted that the CI was able to run three miles in 27 minutes, a minute within the maximum allowed, but was unable to keep up on company runs. His SOB and mild chest pain occurred only with physical exertion. He was otherwise able to march and perform his military duties. His medication regimen included a daily fluticasone/salmeterol inhaler (anti-inflammatory-bronchodilator combination) and an additional short acting inhaled bronchodilator to be used as needed. The lung exam was normal. An outpatient STR note in August 2003 (3 months prior to separation) indicated the CI’s medication regimen was unchanged. An outpatient evaluation for acute traumatic pain in February 2005 (15 months after separation) reported that he did not have a primary care provider and that his only present medication was for pain. At a VA clinic visit in September 2005 the only active medication listed was an inhaled bronchodilator as needed. There were two PFTs 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
 PFT ~13 Mo. Pre-Sep PFT ~ 9 Mo. Pre-Sep
FEV1 (% Predicted)
 77 73
FEV1/FVC
 8 6 % 83%
Meds
 Daily triamcinolone & albuterol inhalers; montelukast Daily fluticasone, salmeterol, prn albuterol; montelukast
§ 4.97 Rating
 10% 10%

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under code 6602 (asthma, bronchial). Board members agreed that a 10% rating was justified by the FEV-1 of 77% and 73% predicted, or by the use of intermittent inhaled bronchodilator therapy. The next higher 30% rating requires daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. The Board deliberated the issue of whether the requirement for daily bronchodilator and/or anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97. The Board takes the reasonable position that the evidence should satisfy an assumption that the treatment regimen supporting the higher rating is necessary to maintain good control of the condition. The reported impairment was isolated to unit runs; the CI otherwise experienced no limitation of physical activities or in the performance of his duties. The sole purpose of prescribed medication was to enable successful completion of the required running. It was noted in this regard that the treadmill test reflected a very high level of exercise intensity that approximated or exceeded that of running; however, SOB did not occur during this test. Moreover, the post-separation notes in evidence indicated that daily bronchodilator or inhalational anti-inflammatory medications were not in use and were not necessary. The Board thus concluded that the 30% criteria were not met. 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 mild persistent 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 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Asthma
 6602 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120608, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         xx
         President
         Physical Disability Board of Review

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