RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
 

 
 

               BRANCH OF SERVICE:  ARMY 
           SEPARATION DATE:  20031120 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200621 
BOARD DATE:  20121113 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SSG/E-6  (11M10/Fighting  Vehicle  Infantryman), 
medically  separated  for  an  asthma  condition.    The  CI  did  not  improve  adequately  with 
treatment  to  satisfy  physical  fitness  standards.    The  CI  developed  shortness  of  breath  and 
coughing with mild exertion and exercise intolerance.  He was prescribed Advair twice a day 
and  Albuterol  as  needed.    He  was  issued  a permanent  P3  profile  and  referred for  a  Medical 
Evaluation Board (MEB).  The MEB was returned for reconsideration and additional testing and 
a NARSUM addendum were considered by the MEB.  The asthma condition was forwarded to 
the Physical Evaluation Board (PEB) as medically unacceptable IAW AR40-501, chpt 3-27c.  The 
MEB  forwarded  no  other  conditions  for  PEB  adjudication.    The  PEB  adjudicated  the  asthma 
condition  as  unfitting  “with  CHCS/Pharmacy  record  noting  intermittent  use  -  no  medications 
from April 2003 until July 2003”, 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. 
 
 
CI CONTENTION:  “The VA has my rating at 80% for service connected disabilities.  The Army 
never addressed all of my conditions.  I was pressured to get out seven years before retirement.  
I was told that I would never make E-7.  I wanted to stay until retirement.” 
 
 
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  asthma  condition  requested  for 
consideration  meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview,  and  is 
accordingly addressed below.  The other unspecified requested conditions are not within the 
Board’s purview.  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 20030829 

VA (4 Mos. Post-Separation) – All Effective Date 20031121 

Condition 

Asthma 

Code 
6602 

Rating 
10% 

No Additional MEB/PEB Entries 

Condition 

Bronchial Asthma 
Patellofemoral, Syndrome, R Knee 
Patellofemoral, Syndrome, L Knee 
Tinnitus 

Code 
6602 
5014 
5014 
6260 

Rating 
10%* 
10% 
10% 
10% 

Exam 

20040324 
20040324 
20040324 
20040324 

Combined:  10% 

0% X 1 / Not Service-Connected x 1 
Combined:  40% 

20040324 

*Asthma increased to 30% effective 20090316 (combined 80%) 
ANALYSIS  SUMMARY:    The  Board  acknowledges  the  CI's  contention  suggesting  that  ratings 
should have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the Army (but later determined to be service-connected by 
the VA).  While the Disability Evaluation System (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 Department of Veterans Affairs (DVA), however, is empowered to compensate 
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  also  acknowledges  the  CI’s  assertions  that  he  was  pressured  to  separate  before 
retirement.  It is noted for the record that the Board has neither the jurisdiction nor authority 
to scrutinize or render opinions in reference to asserted improprieties in the disposition of a 
case.  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.  It must also judge the fairness of PEB fitness adjudications 
based on the fitness consequences of conditions as they existed at the time of separation. 
 
Asthma Condition.  The pulmonary and pulmonary function test (PFTs) 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. 
 

Pulmonary Exam 
FEV1 (% Predicted) 

FEV1/FVC 

Meds 

~5 Mo. Pre-Sep 

MEB Addendum ~4 Mo. Pre-Sep 

VA C&P ~7 Mo. Post-Sep 

76% 
85% 

Ref 5 Mo. Pre-Sep PFTs 

Albuterol as needed, 
Advair twice daily; 
1 course systemic steroids 
past year 

Advair(dose increased) twice 
daily, Albuterol as needed, 
Optimally managed…current 
medication course 

-- 
-- 

Advair twice daily, Albuterol as 
needed, Allegra daily; fine 
expiratory wheezes bilat 

§4.97 Rating 

30% 

30% (PEB 10%) 

30% (VA 10%) 

 
The CI presented with exercise intolerance in October 2002, a year prior to separation.  He was 
treated  with  inhaled  Advair  (artificial  steroid,  w/  anti-inflammatory)  twice  daily  and  inhaled 
Albuterol  (bronchodilator)  as  needed  “but  was  still  unable  to  perform  running  and  heavy 
exertional  activities.”    He  was  placed  on  a  P3  profile  which  triggered  the  MEB.    At  the  MEB 
exam,  performed  8  months  prior  to  separation,  the  CI  reported  some  improvement  in  his 
shortness of breath and cough with medications, but continued exercise and heavy exertional 
activity  intolerance.    The  MEB  physical  exam  noted  normal  lung  exam,  and  a  post-
bronchodilator FEV of 79%.  His medications were Advair twice daily and Albuterol as needed.  
The  MEB  Addendum  5  months  prior  to  separation  described  the  asthma  condition  as 
“moderate in nature and being optimally managed on the patient’s current medications” and 
PFTs  as  described  above.    The  CI  was  also  evaluated  for  paradoxical  vocal  cord  dysfunction 
(including  bronchoscopy  in  June  2003),  which  was  “stable  and  not  amenable  to  further 
treatment.”  The service treatment records (STR) documented several visits to the CHMC with 
complaints of shortness of breath and activity intolerance.  The STR also documented receipt of 
nebulizer treatments and prescription refills at the CHMC. 
 

At the VA examination, performed 7 months after separation, the CI reported daily inhaler use.  
The  physical  exam  demonstrated  fine  expiratory  wheezes  bilaterally  in  posterior  lung  fields.  
PFTs were stated as pending, with no VA PFTs proximate to that exam date in evidence.  The 
Board directs attention to its rating recommendation based on the above evidence.  The VA 
rated the asthma at 10% coded 6602, however the exam and rating narrative indicated daily 
inhaled  medication  use  (including  an  artificial  steroid).    [VARD  “Your  VA  examination  shows 
your therapy consists of three different inhaled medications on a daily basis.  You last used oral 
steroids in January 2003.  You have daily wheeze and cough.  Examination of the lungs revealed 
fine expiratory wheezes bilaterally.  Service connection for bronchial asthma is granted with an 
evaluation of 10 percent disabling effective 23 November 2003, date following discharge.”]   
 
The  PEB’s  DA  Form  199  disability  description  “Asthma  with  CHCS/Pharmacy  record  noting 
intermittent use - no medications from April 2003 until July 2003” makes it clear that its 10% 
rating for asthma was derived from the VASRD, without daily medication use (“CHCS/Pharmacy 
record noting intermittent use”).  It is clear that the CI’s PFTs would not justify a rating higher 
than 10%.  The use of daily inhaled corticosteroids and bronchodilators would justify a rating of 
30%.  The key question to the Board was whether there was reasonable doubt as to the CI’s 
severity based on medication use. 
 
The  CI  was  seen  by  military  and  private  physicians.    All  treatment  notes  and  the  VA  exam 
indicated  daily  inhaled  medication  use.    The  CI  was  treated  with  oral  steroids  by  a  private 
physician which was noted in the service asthma outpatient documentation, but no oral steroid 
medication  was  noted  in  the  CHCS/Pharmacy  record  medication  profile.    The  CI  was  also 
treated  with  Nystatin  for  oral  thrush  in June  2003.    Oral  thrush  is  not usually  seen  in  adults 
except with immune suppression (chronic systemic steroid use or diseases), or as most likely in 
this  case  the  use  of  inhaled  corticosteroids  when  used  without  ideal  technique  (inhaled 
medication deposits too much in the mouth). 
 
The  Board  discussed  at  length  the  probative  value  of  the  treatment  records  indicating  daily 
medication  use  and  the  CHCS/Pharmacy  record  documenting  no  CHCS  dispensed  inhaled 
controller  medication  for  a  4-month  period  adjudged  by  the  PEB  to  indicate  intermittent 
inhaled medication use.  Given the CI’s prescribed Advair dosing of one puff twice a day, two 
canisters  of  Advair  from  any  source  not  captured  by  the  CHCS/Pharmacy  record  medication 
profile would cover that timeframe.  The Board considered that the CHCS/Pharmacy record did 
not include the oral steroids that were clearly prescribed by a civilian physician and per multiple 
treatment records were taken by the CI.  The Board also noted that CHCS/Pharmacy records, 
especially in 2003, did not include any civilian pharmacy provided medication or medications 
issued  from  outside  the  main  pharmacy  such  as  clinic  medication  cabinets,  emergency 
departments/inpatient sources (such as pulmonary testing labs or bronchoscope labs), or from 
civilian provider’s direct dispensing from samples or other sources. 
 
After review of the entirety of the evidence on the CI’s medication history, the Board majority 
determined that there was reasonable evidence that the CI had access to multiple providers for 
his prescriptions which were very likely not reflected in the CHCS/Pharmacy record medication 
profile.  All treatment notes and histories indicated “daily inhalational or oral bronchodilator 
therapy,  or;  inhalational  anti-inflammatory  medication”  which  met  the  30%  rating  criteria.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board majority recommends a disability rating of 30% for the 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, the Board by a vote of 2:1, recommends 
a  disability  rating  of  30%,  coded  6602  IAW  VASRD  §4.97.    The  single  voter  for  dissent  (who 
recommended  no  recharacterization  of  asthma  at  10%)  submitted  the  appended  minority 
opinion.  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: 
 

VASRD CODE 

RATING 

30% 
30% 

6602 

COMBINED 

UNFITTING CONDITION 
Asthma 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120605, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
            
 
 
 

                 
            

          XXXXXXXXXXXXXXXXXXX 
 
 

     President 
     Physical Disability Board of Review 

MINORITY OPINION: 
 
The minority voter agrees with the statement in the above proceedings that, “The key question 
to  the  Board  was  whether  there  was  reasonable  doubt  as  to  the  CI’s  severity  based  on 
medication use.”  The PEB rated the asthma condition at 10% based upon what they considered 
insufficient  evidence  demonstrating  that  the  CI  was  actually  taking  “the  daily  inhalational  or 
oral bronchodilator therapy, or; inhalational anti-inflammatory medication” as required by the 
VASRD  Code  6602  to  reach  the  30%  rating.    The  PEB  stated,  “Asthma  with  CHCS/Pharmacy 
record noting intermittent use - no medications from April 2003 until July 2003.”  A review of 
the  pharmacy  records  in  evidence  validates  the  PEB’s  observations.    The  board  discussion 
hinged upon the assumption that the CI “allegedly” received additional asthma medications and 
refills from his non-military physician during the aforementioned period of April 2003 until July 
2003.    This  explanation  falls  short  in  that  if  the  civilian  prescriptions  were  not  filled  at  the 
military facility (the more logical course of action from a personal financial perspective, and one 
that would have been captured by the evidence at hand); then civilian pharmacy records would 
logically have been presented to refute the PEB finding.  Likewise it is unreasonably speculative 
to conclude that all of the undispensed medications were garnered as physician office samples.  
The  minority  voter  believes  that  there  is  insufficient  objective  evidence  and  an  overly 
speculative rationale, even with liberal concession of reasonable doubt, to support the majority 
conclusion which was the keystone for elevating the rating to 30%.  The minority opinion was 
apparently shared by the VA rating official who conferred a 10% rating.  When challenged with 
this argument, the majority response was that the rating official made an “error.”  The minority 
voter does not find enough benefit of the doubt to declare that the VA rating official was in 
error, along with the members of the PEB. 
 
The Secretary is respectfully urged to consider the minority recommendation that there be no 
recharacterization of the CI’s disability and separation determination, as follows: 
 

UNFITTING CONDITION 

VASRD CODE  RATING 

6602 

COMBINED 

10% 
10% 

Asthma 

 
 

 

 

DEPARTMENT OF THE ARMY 
251 18TH STREET SOUTH, SUITE 385 

ARMY REVIEW BOARDS AGENCY 

ARLINGTON, VA  22202-3531 

 
 

 

 

 

 

 

 

 

 

 
SFMR-RB 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:    Department  of  Defense  Physical  Disability  Board  of  Review  Recommendation  for 
XXXXXXXXXXXXXXXXXXX, AR20120021793 (PD201200621) 
 
 
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 accept the Board’s minority opinion as accurate that 
the  applicant’s  final  Physical  Evaluation  Board  disability  rating  remains  unchanged.    There  is 
insufficient justification to support the Board’s recommendation in accordance with Army and 
Department of Defense regulations.   
 
2.    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 
 
 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 
 
 
 
 

     XXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

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