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AF | PDBR | CY2013 | PD-2013-02736
Original file (PD-2013-02736.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02736
BRANCH OF SERVICE: Army  BOARD DATE: 20150320
SEPARATION DATE: 20070731


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Trainee) medically separated for asthma. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent P3L2 profile and referred for a Medical Evaluation Board (MEB). The conditions characterized as “obstructive lung disease” and “asthma,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Two other conditions (right 5th metatarsal fracture and right inguinal hernia repair), were submitted by the MEB. The Informal PEB combined the two conditions and adjudicated “asthma,” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “Army only looked at one condition, Asthma and rated me at 10%. VA rated me at 30% for Asthma plus 60% for my heart. VA used my Army Service records to award my claim. Did not rate my TBI. Amy did not even look at my TBI which happened on May 4, 2007 (See enclosed military report) Due to his TBI he now has residual cognitive impairment and PTSD which VA has still not recognized and is on appeal.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

IPEB – Dated 20070713
 VA* - (~8 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Asthma/Obstructive Pulmonary Disease 6604-6602 30% 20080211
Other x2 (Not in Scope)
 Other x 6
RATING: 10%
 RATING: 80%
*Derived from VA Rating Decision (VARD) dated 20080917 (most proximate to date of separation [ DOS ] )

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation. Additionally, the Board acknowledges the presence of a heart condition as a service-connected condition by the VA, but notes that the scope of its recommendations does not extend to conditions which were not diagnosed or in evidence at the time of medical separation. The VA did not grant service-connection for the contended TBI (post-concussion condition) or the PTSD condition, also not diagnosed or in evidence at the time of medical separation.

Asthma Condition. The CI developed shortness of breath and left sided chest pain in August 2006 with wheezing heard on exam. CI was a non-smoker. He was diagnosed with bronchitis and treated with antibiotics, inhaled bronchodilator medication and a steroid injection. In October 2006, he underwent pulmonary function tests (PFTs) which revealed severe airway obstruction that was reversed with inhaled bronchodilator medication. Chest X-ray showed evidence of slight hyperinflation of the lung parenchyma with slight tenting of the diaphragm, no infiltrates, effusion, and no hilar adenopathy. He was prescribed inhaled corticosteroid medication along with a short course of oral steroids. His shortness of breath did not respond to treatment and the CI was referred for further testing. He underwent bronchoscopy (a scope placed within the bronchial tubes) that revealed mild increase in size of the bronchial tubes, cardiac exercise stress test that suggested either poor conditioning or cardiac limitation to exercise, and echocardiogram that was essentially normal. He likewise underwent a CT scan of the chest which demonstrated the lungs were well aerated with normal pulmonary vasculature and no focal air space disease, no evidence of emphysema and no effusions and normal airways and normal pleura. When the CI’s continued to experience difficulty breathing with exertion he was referred into the Disability Evaluation System.

The narrative summary (NARSUM) prepared 4 months prior to separation noted the onset of symptoms while undergoing Basic Training and the CI had significant dyspnea while running the physical fitness test. Pertinent physical exam findings were: Chest: Normal on visual inspection; Lungs: Clear to auscultation with no prolonged expiratory time and no changes in inspiratory/expiratory ratio; and Cardiovascular: regular rate and rhythm without murmurs. Medications at that time included inhaled bronchodilator as needed and daily inhaled corticosteroid medicate

At the VA Compensation and Pension exam performed 8 months after separation, the CI reported they ruled cystic fibrosis/emphysema. He was diagnosed with obstructive lung disease and treated with inhaler Advair and also had Prednisone (a course) of tablets 2 months after separation. He reported asthma attacks at least once a day. Current treatment was Advair twice a day, ProAir inhaler about 10 times a day, but it did not help. Physical exam revealed normal respirations with clear lungs and normal cardiac exam.

P FTs
 NARSUM ~7 Mo. Pre-Sep PFT ~1 Mo. Pre-Sep VA C&P PFTs 7 Mo. Post-Sep
FEV1 (% Predicted)
 44 84 81
FEV1/FVC
 57 83 100
Meds
 Inhaled bronchodilator & corticosteroid Inhaled bronchodilator & corticosteroid Inhaled bronchodilator & corticosteroid
§ 4.97 Rating
 6 0% (PEB 10%) 30% 30% (VA 30%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the asthma as 6602 (Asthma) and rated at 10%. The VA coded the asthma/obstructive pulmonary disease (6604-6602) and rated it 30%. The CI was prescribed a daily inhaled corticosteroid medication (Advair) in October 2006. The NARSUM referenced PFTs that documented an FEV1 value that is consistent with the 60% VASRD rating criteria 7 Dmonths prior to separation. The evidence contained PFT results from 1-month prior to separation that documented non-compensable PFT results that were supported by similar PFT results obtained by the VA seven months after separation. The Board notes that the CI was prescribed and reported using the inhaled corticosteroid medication on a daily basis. The Board agreed that the CI met the 30% criteria of daily 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 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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION
 VASRD CODE RATING
Asthma 6602 30%
COMBINED
 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131219, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record
XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXXXX, AR20150012755 (PD201302736)


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:




Encl                       XXXXXXXXXXXXXXXXXXXX
                                    Deputy Assistant Secretary of the Army
                                    (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA







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