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AF | PDBR | CY2013 | PD-2013-01908
Original file (PD-2013-01908.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE : PD -20 13 - 0 1908
BRANCH OF SERVICE: NAVY   BOARD DATE: 201 4 0711
Separation Date: 20040617


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty AD2/E5 (AD 6420 F404 Turbofan Jet Engine First Degree/MA Mechanic and a former 8842 F/A18 Maintenance Technician) medically separated for an asthma condition. He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). The bronchial asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated bronchial asthma as Category I (unfitting) rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : The CI elaborated no specific contention in his application.


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 Category I (unfitting) asthma condition is addressed below. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.


 RATING COMPARISON :
invalid font number 31502
Service IPEB – Dated 20040227
 VA* - (3.6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bronchial Asthma 6602 10% Obstructive Lung Disease and Allergic Asthma 6604 30% 20041119
Other x 0 (Not in Scope)
 Other x8
Combined: 10%
 Combined: 70%
* Derived from VA Rating Decision (VARD) dated 20041119 (most prox imate to date of separation)


ANALYSIS SUMMARY : IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus 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 ratable severity at the time of separation.

Bronchial Asthma Condition : The CI has a well-documented history of bronchial asthma that started in 1997. He was seen in the emergency room ( ER ) in 1997 and urgent care in 1998 for acute bronchospasm. The primary care provider initially diagnosed bronchitis with bronchospasm and treated with antibiotics and prednisone, and chest X -ray showed bronchiti s related changes in the lungs. In April 2000, the CI was seen in the ER for acute bronchitis and in May 2000 he required transport ation to a civilian emergent care for status asthmaticus. Pulmonary f unction t est (PFT ) done on 24 May 2000 demonstrated a forced expiratory volume ( FEV1 ) 87% predicted and a FEV1/ forced vital capacity ( FVC ) 85% predicted which was interpreted as normal. In 2002, the CI was seen by primary care and prescribed steroids for an asthma exacerbation and noted to be using Flovent daily and A lbuterol inhaler 3 to 4 times a day . He was seen by p ulmonary and was noted to have wheezing at night. The examiner diagnosed mild persistent asthma and prescribed Advair (inhalational anti-inflammatory drug) daily. The CI failed two physical readiness training (PRT) cycles due to wheezing and shortness of breath ( SOB) with running. The CI was placed on a 6 month LIMDU on 4 September 2002 for asthma and documented a treatment plan of Advair one puff 2 times a day with specific limitations of no overseas deployment and to avoid fumes, and smoke. A bronchospasm induced test was positive for asthma. The CI was compliant with all of his asthmatic medications and Pulmonary noted an improvement in the asthma . The CI was found fit for duty on 15 January 2003. After the CI was returned to full duty, he failed another PRT and following this test, he continued to have several hours of SOB . The CI was seen by medical clinic on ship for an asthma exacerbation and was given an albuterol nebulizer treatment and advised to continue Advair daily and albuterol as needed. A PFT showed an FEV1 of 87% and an FEV1/FVC of 84%. The pulmonologist noted that the CI usually had exercise related asthmatic symptoms and occasionally at rest and the lung exam showed bilateral expiratory wheezing. A Methacholin e challenge t est dated 7 Octo ber 2003 demonstrated reactive airway disease. The p ulmonologist saw the CI after the test and added Singulair ( leukotriene) 10mg daily to his Advair regimen. The MEB n arrative s ummary (exam approximately 7 months prior to separation documented that the CI continued with asthma symptoms despite being complaint with his Advair 500mg/50 twice a day , Singulair 10mg daily and Proventil inhaler before during and after exercising . The examiner further opined that the CI’s asthma interfered with the reasonable performance of his assigned duties. The non-medical assessment dated 29   December 2003 documented that the CI’s medical condition did not interfere with his watch standing or work center responsibilities ; however he was not recommended for retention and his promotion recommendation was problem atic due to failing three physical fitness assessments in a 4 - year period. The CI was seen by p ulmonary and noted to be compliant with his medications of Advair, Singular and Albu terol … The VA Compensation and Pension exam approximately 3 months after separation documented physical exam findings of lung slightly prolonged expiratory phase which improved after a cough reflex. He continued to be compliant with his Advair 500mg/50 twice a day, Singulair 10mg daily and Proventil inhaler before during and after exercising medications. PFT’s were not done at this exam.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the bronchial asthma condition as 6602 and rated at 10%. The VA coded the obstructive lung disease and allergic asthma as 6604 chronic obstructive pulmonary disease and rated at 30% FEV 1 of 56 to 70% predicted , or; FEV1/FVC of 56 to 70% or ; DLCO (SB) 56 to 65% predicted. The Board cannot explain why the VA u s ed the COPD coding instead of the asthma coding, however in their rating explanation the VA rated 30% based on daily inhalational anti-inflammatory drug use. All exams performed proximate to separation documented that the use d an inhalational anti-inflammatory drug on a daily basis . The Board reviewed the 10% criteria of intermittent inhalational or oral bronchodilator therapy versus 30% inhalational anti-inflammatory medication. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30 % for the bronchial 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 bronchial 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 his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Bronchial Asthma 6602 3 0%
COMBINED 3 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131006 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record









                          
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

invalid font number 31502



MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
                  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 26 Feb 15 XXXXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 21 Jan 15 ICO XXXXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 13 Jan 15 ICO XXXXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 5 Feb 13 ICO XXXXXXXXXXXXXXXXX
         (f) PDBR ltr dtd 28 Feb 15 ICO XXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. XXXXXXXXXXXXXXX, former USN : Disability separation with final disability rating of 10 percent (increased from 0 percent) effective date of discharge.

b. XXXXXXXXXXXXXXX, former USN : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

c. XXXXXXXXXXXXXXX, former USN : Placement on the Permanent Disability Retired List with a 70 percent disability rating effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

e. XXXXXXXXXXXXXXX, former USMC : Disability separation with final disability rating of 10 percent (increased from 0 percent) effective date of discharge.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.



          XXXXXXXXXXXXXXX
         Assistant General Counsel
                  (Manpower & Reserve Affairs)

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