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AF | PDBR | CY2013 | PD-2013-02784
Original file (PD-2013-02784.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02784
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20140716
SEPARATION DATE: 20060515


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was an active duty LCPL/E-3 (0621/Field Radio Operator) medically separated for asthma. The condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty or physical fitness standards; she was placed on limited duty and referred for a Medical Evaluation Board (MEB). The asthma condition, characterized as “ unspecified asthma , ” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded two other conditions ( toxic effect of unspecified gas fume or vapor and allergic rhinitis) for PEB adjudication. The Informal PEB adjudicated the asthma as a Category I condition, rated at 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) . With regard to the remaining conditions , Category III ( toxic effect of unspecified gas fume ) was determined to be not unfitting and Category IV ( allergic rhinitis ) was determined to not constitute a physical disabilit y . The CI made no appeals and was medically separated .


CI CONTENTION: “DD-214 Form included; VA medical records are/may be reviewed (due to reentry code cannot reenter service due to disability.)”


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 Naval Records.


RATING COMPARISON :

Service IPEB – Dated 20060321
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Exercise-Induced Asthma 6699-6602 0% Exercise Inducted Asthma 6602 30% 20060715
Allergic Rhinitis CAT III Allergic Rhinitis 6522 NSC 20060715
History o f Inhalational Exposure to Potentially Toxic Substance CAT IV No VA Entry
No Additional Conditions in Scope
 No Other VA Conditions in Scope
Combined: 0%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 60922


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.
Asthma Condition. The CI developed shortness of breath and light-headedness during exercise in early 2004. She was evaluated and treated in the emergency several times prior to undergoing a formal evaluation. She underwent comprehensive cardiac and neurological evaluations that were both normal. She deployed to Iraq from July 2004 until March 2005 when she was returned state-side because the frequency of her medical visits negatively impacted her unit’s mission effectiveness. Her symptoms persisted and in May 2005 she had a pulmonary function test (PFTs) performed before and after exercise. That test documented a significant drop in her pulmonary function (22% decrease in forced expiratory volume in 1 second [FEV1]), during exercise which was consistent with exercise induced asthma. She was treated with inhalational bronchodilator medication (Albuterol) prior to exercise which did not work. Inhalational steroids and anti-inflammatory medication (Singulair) were added to the regime without benefit. A note in the service treatment record dated 2 February 2006 documents that the inhaled steroid medication and Singulair were discontinued at that time, while the Albuterol was continued on an as needed basis.

The narrative summary (NARSUM) (accomplished 3 months prior to separation) confirmed the above historical events. The examiner documented her asthma related medication was only Albuterol before exercise and as needed. The CI’s lung examination was normal and she was diagnosed with exercise induced asthma that was “…refractory to multiple medical treatments including inhaled steroids, beta-agonists, and leukotriene inhibitors.” Also documented the following “For management of her exercise-induced asthma, patient should continue her inhaler therapy consisting of Albuterol before exertion and also during times of symptom exacerbation.”

The VA Compensation and Pension (C&P) examination (performed 2 months after separation) contained the following statement:

“She states a lithium battery exploded in her face and since that point has had difficulty exercising. Overall she feels her condition is stable. She is not on any current treatment. She states her symptoms include shortness of breath with exertion. She is limited in that she gets short of breath walking upstairs and cannot run more than approximately a mile. She has not been hospitalized or had surgery secondary to this condition.”

Her lung exam was normal. The C&P exam documented that her chest X-ray images was normal and quoted that the PFTs performed on 20 May 2005 demonstrated a pre-exercise FEV1 of 84 percent predicted with a FEV-1/FVC of 84 percent and a post exercise FEV1 of 65% with a change of 22% consistent with exercise induced asthma. In September 2006, the VA granted a 30% evaluation for her asthma citing:

“Your treatment plan was for Advair to optimize inhaler therapy in addition Albuterol as needed. You underwent examination during July 2006 at the Nashville TN VA Medical Center in support of this claim. During this examination you stated that you were not on any current treatment for the condition. You reported symptoms of shortness of breath with exertion. You reported getting short of breath walking upstairs and cannot run more than a mile. After reviewing and analyzing the cited evidence an evaluation of 30 percent is assigned. The criteria for a 30 percent evaluation more closely represent your symptoms.”

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the exercise induced asthma by applying the analogous VASRD code 6699-6602 (bronchial asthma) and rated at 0%. The VA applied VASRD code 6602 and rated at 30% with the VARD containing the rating statements noted above. The two pertinent rating criteria for this case, under code 6602, are copied below for the reader’s convenience:

FEV–1 of 56- to 70-percent predicted, or; FEV–1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication........ 30%

FEV–1 of 71- to 80-percent predicted, or; FEV–1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy................................................................ 10%

The service treatment record documents that the CI’s asthma was refractory to daily inhalational steroid medications which were discontinued prior to separation. Her management plan was to use Albuterol prior to exercise and as needed. Two months after separation, the C&P exam corroborates that the CI was not taking any medication for her asthma condition. The CI’s baseline PFTs were essentially normal and did not meet the 10% rating criteria. The Board reviewed the evidence and members agree that the CI required inhalational bronchodilator therapy on an intermittent, as needed basis; with no daily asthma medication required. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the exercised induced 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 exercised induced asthma condition, the Board unanimously recommends a disability rating of 10%, 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, effective as of the date of her prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Exercised Induced Asthma 6602 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131217, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review


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 25 Mar 15 ICO XXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 26 Feb 15 ICO XXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 25 Mar 15 ICO XXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 24 Mar 15 ICO XXXXXXXXXXXXXXX

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

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

a. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a 10 percent (increased from 0 percent) disability rating effective date of discharge.

b. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a 20 percent (increased from 0 percent) disability rating effective date of discharge.

c. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a 20 percent (increased from 10 percent) disability rating effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC : Entitlement to disability severance pay with a 10 percent (increased from 0 percent) disability rating 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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