RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20030612 

 
NAME:  XXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200894 
BOARD DATE:  20130124 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  Soldier,  SGT/E-5(77F/Fuel  Handler),  medically 
separated for an asthma condition.  The CI did not improve adequately with treatment to meet 
the  physical  requirements  of  her  Military  Occupational  Specialty  (MOS);  meet  worldwide 
deployment  standards  or  satisfy  physical  fitness  standards.    She  was  issued  a  permanent  P3 
profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB  forwarded  moderate 
persistent  asthma  IAW  AR  40-501.    No  other  conditions  appeared  on the  MEB’s  submission.  
The Physical Evaluation Board PEB adjudicated the asthma condition as unfitting, rated 10%, 
with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made 
no appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  The CI states: “1) I was not informed of appeal options when final decision 
was presented; 2) I was diagnosed by Dr. --- in March 2000 at Martin Army Community Hospital 
ER at Ft. Benning and began follow-up care at Ft. Hood with Dr. -- at TMC 6 & Thomas Moore 
Health Clinic, which enrolled me in the asthma program/class; 3) Decision seems to have been 
made due to Rx profile which only shows prescriptions beginning in 2002 (according to AHLTA), 
which presents a gap/missing information from date of diagnosis(2000); 4) Various instructions 
were given regarding usage of Albuterol by various providers (first told to use on daily basis, 
then  instructed(by  other  providers  conducting  medication  reconciliation  process  when  being 
seen  for  other  issues)  to  use  other  inhalers  on  a  daily  basis  and  Albuterol  is  used  only  as  a 
rescue inhaler when other medications fail; 5) I've used home remedy of hot tea, honey, and 
lemon  juice  mixture  to  alleviate  flare  up  symptoms  as  well  as  eating  a  tablespoon  of  warm 
honey  to  control  wheezing  since  diagnosis;  6)  Was  enrolled  in  EFMP  at  Ft.  Hood  after  my 
discharge from service and issued a nebulizer, which I currently still use; 7) Condition has not 
gotten  any  better  and  still  limits  my  activities(various  factors  causes  flare  ups  ....  allergies, 
strenuous activities, weather/temperature changes, coughing, laughing, etc).”   
 
 
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 remaining conditions rated by the VA 
at  separation  and  listed  on  the  DD  Form  294  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. 
 
 
 
 
 
 
 

VA (4 Mos. Pre-Separation) – All Effective Date 20030613 
Rating 
Condition 
30% 
Asthma 
Left  Knee  Patellofemoral  Pain 
10% 
Syndrome 
Low Back Strain 
10% 
0% X 3 / Not Service-Connected x 1 
Combined:  40% 

Code 
6602 
5299-5024 
5295 

Exam 
20030220 
20030220 
20030220 
20030220 

Combined: 10% 

 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s opinion that she was not informed of 
an appeals option, that the service record shows a gap of missing medication profiles from the 
time she was diagnosed with asthma and finally that she had various instructions regarding the 
use of her inhalers.  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  or  faulty  medical  care.    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. 
 
Asthma Condition.  The CI sought care in the emergency room for difficulty breathing in March 
2000 and was diagnosed with acute asthma which necessitated treatments with subcutaneous 
epinephrine  (emergent  treatment  for  severe  allergic  or  severe  airway  compromise),  beta 
agonist nebulizer treatments and injectable steroid treatment.  There was a paucity of evidence 
since  this  emergent  encounter  for  treatment  of  asthma  until  August  2002.    This  entry 
documented  that  she  had  been  to  an  asthma  class,  had  a  received  a  spacer,  had  used  her 
albuterol  3  times  in  2  weeks  and  reported  no  night  symptoms  for  the  past  2  weeks.    The 
examiner prescribed the anti-inflammatory inhaler Flovent and the beta agonist Albuterol with 
the instructions “use as necessary until she feels better.”  She was not seen by pulmonary until 
February 2003 who documented she had had multiple visits for asthma since her emergency 
room  visit,  was  using  the  medications  Albuterol,  Flovent,  and  Serevent  (long  acting  beta 
agonist)  for  the  last  2-3  months  and  was  passing  her  physical  training  tests  however  had 
difficulty  performing  MOPP  training.    The  examiner  diagnosed  moderate  persistent  asthma.  
The  medication  profile  reflected  prescriptions  for  the  asthma  medications  Flovent,  Serevent, 
and Albuterol, the allergy medications Flonase and Zyrtec prior to separation.  After separation, 
the  medication  profile  reflected  the  asthma  medications  Advair  and  Singulair  and  allergy 
medication  Nasonex  and  Zyrtec.    The  permanent  profile  limitations  included  an  alternate 
physical training test, walk and run at own pace and distance and no use of protective mask.  
The commander’s statement corroborated her medical condition, limitations and additionally 
documented she had difficulty performing her duties in smoky or confined areas and could only 
perform office duties under her MOS.  There were no hospitalizations or episodes of respiratory 
failure  in  evidence.    There  was  one  pulmonary  function  test  (PFT)  in  evidence,  with 
documentation of additional ratable criteria, which the Board weighed in arriving at its rating 
recommendation; as summarized in the chart below.   
 

RATING COMPARISON:   
 

Service PEB – Dated 20030417 
Condition 
Asthma 

Code 
6602 

↓No Additional MEB/PEB Entries↓ 

Rating 
10% 

DOS 20030612 

Pulmonary Exam 
FEV1 (% Predicted) 
FEV1/FVC 

Meds 

§4.97 Rating 

*Based on PFT criteria alone 
 

MEB ~3 Mo. Pre-Sep 
84 
88 
Albuterol 
Flovent, Serevent, Flonase 
10%* vs.30% 

as 

needed; 

   2                                                           PD1200894 
 

At the MEB exam the CI reported she was using her Albuterol several times daily.  The MEB 
physical  exam  demonstrated  normal  head,  ears,  nose  mouth,  throat  and  cardiopulmonary 
findings.  Spirometry was unremarkable and revealed no significant change with bronchodilator 
medication.  A methacholine challenge study was contraindicated due to her previous known 
asthma exacerbations.  The examiner diagnosed moderate persistent asthma and opined the 
current clinical condition required the use of daily controller medications and that her condition 
was stable at this time.  At the VA Compensation and Pension (C&P) exam, prior to separation, 
the CI reported attacks three to four times per week, both day and night, currently took the 
asthma medications; Albuterol, Serevent, and Flovent and the allergy medications Zyrtec and 
Flonase which helped her sinus congestion.  The C&P exam demonstrated clear drainage of the 
nose,  tenderness  of  the  frontal  sinuses  and  normal  cardiopulmonary  findings.    A  Computer 
Tomography (CT) sinus X-ray revealed marked edema of the turbinate’s and an abnormal right 
osteomeatal  complex.    The  examiner  referenced  the  service  PFT’s  and  diagnosed  mild  to 
moderate persistent asthma and seasonal allergic rhinitis. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA applied the same VASRD code 6602 (Asthma, bronchial) and were subject to the 
same rating criteria IAW §4.97—Schedule of ratings–respiratory system.  VASRD §4.97 rating 
criteria for asthma are based on the number and severity of clinical exacerbations; the type and 
the  frequency  of  medications  used  to  treat  the  condition;  and  PFT  values  for  FEV1  and 
FEV1/FVC  ratio.    IAW  VASRD  §4.96  special  provisions  regarding  evaluation  of  respiratory 
conditions  PFT’s  are  required  to  evaluate  respiratory  conditions  unless  the  condition  meets 
exception to this requirement which in this case it did not.  VASRD §4.96 also 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  exam  are  post-
bronchodilator  measurements  as  specified  by  §4.96  and  further  acknowledges  the  exam  is 
normal and 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  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 10% rating as the 
medication profile did not reflect quantities compatible with daily therapy.  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 action officer opines the CI’s asthma impairment meets the requirement for daily 
inhalational anti-inflammatory medication as the condition is classified as moderate persistent 
asthma  which  is  treated  with  daily  anti-inflammatory  medication  as  the  first  line  treatment.  
Furthermore  the  evidence  reflects  the  persistence  of  symptoms  and  additionally  medication 
instructions that  were  inconsistent  with  her  disease  process.    Finally, the  evidence  supports, 
prior to  separation,  active  prescription  management,  changing  from  Flovent  and  Serevent  to 
Advair and the addition of Singulair, reflecting good faith in the CI seeking care to manage and 
optimize her  asthma.    After due deliberation,  considering  all  of  the  evidence  and  mindful  of 

   3                                                           PD1200894 
 

VASRD §4.3 (Resolution of reasonable doubt), the Board 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 unanimously recommends a 
disability rating of 30%, coded 6602 IAW VASRD §4.97.  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 
Asthma 

VASRD CODE  RATING 
6602 
COMBINED 

30% 
30% 

 
 
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 
           Physical Disability Board of Review 

   4                                                           PD1200894 
 

 
 
SFMR-RB 
 

 

 
 

 

 

 
 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency  

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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  

for xxxxxxxxxxxxxxxxxxx, AR20130003486 (PD201200894) 

 
 

 
 

 
 

 

 

 

 

 

 
 
 
 
 
 

 

 
 
 
 
 

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 30% 
effective the date of the individual’s original medical separation for disability with severance 

pay.   

2.  I direct that all the Department of the Army records of the individual concerned be corrected 

accordingly no later than 120 days from the date of this memorandum: 

 

a.  Providing a correction to the individual’s separation document showing that the 

individual was separated by reason of permanent disability retirement effective the date of the 

original medical separation for disability with severance pay. 

 

b.  Providing orders showing that the individual was retired with permanent disability 

effective the date of the original medical separation for disability with severance pay. 

 
c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 30% 

effective the date of the original medical separation for disability with severance pay. 

 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

medical TRICARE retiree options. 

3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 

to the Army Review Boards Agency with a copy of this memorandum without enclosures. 

BY ORDER OF THE SECRETARY OF THE ARMY: 

   5                                                           PD1200894 
 

 

Encl 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

     xxxxxxxxxxxxxxxxxx 

     Deputy Assistant Secretary 
         (Army Review Boards) 

 

 

 

 

   6                                                           PD1200894