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AF | PDBR | CY2013 | PD-2013-02500
Original file (PD-2013-02500.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02500
BRANCH OF SERVICE: Army  BOARD DATE: 20140826
SEPARATION DATE: 20060214


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (63B/Mechanic) medically separated for an asthma condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent P3/L3 profile and referred for a Medical Evaluation Board (MEB). The asthma condition was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “asthma” as unfitting, rated 10% using the VA Schedule of Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “My asthma was the only condition evaluated at my MEB. I had other conditions on the profile that was rated as P3, for my back and piriformis syndrome.”


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; no additional conditions are within the DoDI 6040.44 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.


 RATING COMPARISON :

Service IPEB – Dated 20060214
 VA - (2 Mos. Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Asthma 6602 10% 20060418
Other MEB/PEB Entries x 0
 Other x 8
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 20060512 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Asthma Condition. The first recorded visit for asthma in the records in evidence was an emergency room visit on 5 May 2003 when the CI was not able to complete a morning run secondary to shortness of breath (SOB). She was placed on medications which were used intermittently. The record falls silent until 2 years later although it appears that she was started and stopped on anti-inflammatory medications. A pulmonary evaluation on 7 March 2005 diagnosed clinical asthma and recommended that she use an inhaled bronchodilator and anti-inflammatory agent daily. Pulmonary function tests (PFTs) showed minimal improvement with bronchodilators and were near normal other than a reduced FEF 25-75. Repeat PFTs 6 months later were similar, but reduced. Review of the medication profile shows that the CI filled her prescription for Advair, an inhaled anti-inflammatory medication, on 26 May 2005, over 8 months prior to separation. She did not refill the medications after that as per the final medical profile current through 4 October 2005. The narrative summary (NARSUM) was dated 9 September 2005 and noted that her PFTs had been read as borderline for asthma. A Methacholine challenge test on 9 March 2005 was positive and asthma was diagnosed. She was issued a permanent P3 profile on 16 August and referred to an MEB. She was noted to be taking Advair and Singulair daily (anti-inflammatory medications) and Albuterol (an airway dilator) as needed. The Board noted that this is not consistent with the refill history cited above. On examination, her lungs were clear and respiratory examination unremarkable. At the VA Compensation and Pension exam performed 2 months after separation, the CI reported a history of SOB with physical activity and that she had been in the emergency room four times in the prior 3 years. Her lungs were clear to examination. The medications in use were not recorded. The VA rater noted that private medical records from Allergy Partners dated 25 May 2005 through 23 March 2006, encompassing the MEB period and separation, documented the use of Albuterol, a bronchodilator, as needed, up to every 6 hours. The PFT 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
Pre/Post Medication		 Pulmonary 11 months Pre-Separation MEB ~ 5 Mo. Pre-Sep VA ~ 2 Mo. Post-Sep
FEV1 (% Predicted) 85/92 84/89 84/ 89
FEV1/FVC% 72/77 69/76 70/ 76
Meds No medications listed No medications listed The evaluator stated that the FEV1 represented her pulmonary condition
§4.97 Rating 10% 30 % 1 0 % (Based on FEV1 )

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the asthma condition at 10% using the code 6602, asthma. There are both PFT and medication criteria upon which the rating is based. The Board considered if a 30% rating was warranted. The Board noted that the pulmonologist prescribed the use of an anti-inflammatory agent and that the MEB and VA PFTs both showed a FEV1/FVC ratio which supported a 30% rating. Although there is a concern of compliance, both support a 30%. However, the Board also observed that while the CI had been recommended the use of an anti-inflammatory at the pulmonary appointment, she had also been started and stopped on these medications over the prior year at different appointments. She reported use of an anti-inflammatory agent at the time of the NARSUM, but the October medication profile does not show that she refilled this medication after she received a 3-month supply in May 2005. Private treatment notes obtained by the VA which bracket the time of separation indicate that she used only a bronchodilator on an as needed basis. This is consistent with a 10% rating. There were three sets of PFTs. The first supports a 10% rating; the second a 30% rating; the third would support a 30% rating except that the reviewer noted that the FEV1, which is consistent with a 10% rating, more accurately reflected the pulmonary status. Accordingly, two of three sets of PFTs support a 10% rating. The Board considered all the evidence and determined that a 10% rating is more consistent with the level of disability in evidence. 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 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 §4.100, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131120, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                                   
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB                                                                         

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150005539 (PD201302500)
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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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