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AF | PDBR | CY2013 | PD2013 01411
Original file (PD2013 01411.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1301411        
BRANCH OF SERVICE: Army  BOARD DATE: 20140122
Date of Permanent SEPARATION: 20040706  


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92F20/Petroleum Fuel Specialist) medically separated for asthma. She first developed episodes of shortness of breath and chest pain in the fall of 2001 without any clear explanation for the symptoms. After multiple trips to the emergency room she identified the source of her symptoms as exposure to petroleum fumes in the workplace. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other conditions were submitted by the MEB. The PEB adjudicated the asthma condition triggered by petroleum vapors, as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her 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 unfitting asthma condition is addressed below; and, 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 20040322
 VA - (2.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Asthma 6602 10% 20040917
No Additional MEB/PEB Entries
 Other x 0 20040917
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 50422 ( most proximate to date of separation [ DOS ] ) with C&P exam . VARD dated 20040917 was the closest to DOS, based on service treatment record ( STR’s ) and had the same 10% rating.


ANALYSIS SUMMARY: The Board must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board considers VA evidence within 12 months of separation only to the extent that it reasonably reflects the disability at the time of separation.

Asthma Condition. Although the CI first developed intermittent respiratory symptoms in 2001, a formal diagnosis of asthma was not established until she was evaluated by a pulmonologist in September 2003. At that time a diagnosis of mild persistent asthma aggravated by exposure to petroleum products was rendered. At the separation exam on 17 November 2003, the CI reported using inhalers “when needed for asthma.” Review of the STR showed one note in evidence documenting the use of an oral steroid for asthma (September 2003). At a clinic visit for bronchitis on 30 December 2003, medications were listed as “OTC (over the counter) cold meds.” The CI requested a refill of Singulair, but Advair was not mentioned by the CI or addressed by the examiner. A review of pharmacy records on 14 March 2004 indicated that prescriptions for Albuterol and Singulair (one month supply) were last filled on 30 December 2003 and for Advair on 14 October 2003. An outpatient clinic entry on 6 January 2004 regarding “MEB issues” (CI desired continuation in the service) indicated that the CI was taking no medications, but a note on 17 February 2004 identified Singulair as a medication. The narrative summary (NARSUM) examiner on 3 February 2004 (5 months prior to separation) noted that the CI could not tolerate exposure to petroleum fumes, which caused shortness of breath, chest pain and coughing. Symptoms were reported to be somewhat mitigated by the daily use of Advair (an inhaled bronchodilator-steroid combination) and oral Singulair and an inhaled Albuterol (bronchodilator) as needed. The examiner did not clarify if medications were in current use. Physical examination of the lungs was normal. The examiner’s diagnosis was mild persistent asthma.

At the VA Compensation and Pension (C&P) exam on 17 September 2004 (2.5 months after separation), the CI reported a cough only with cold weather. The examiner noted that the CI had been given Singulair and Albuterol, but made no mention of Advair or other inhaled steroids. Her most recent asthma attack was a week prior for which she used her Albuterol inhaler. Physical examination of the lungs was normal. The assessment was “asthma with current use of metered dose inhaler.” The pulmonary function 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
 NARSUM ~ 5 Mo s . Pre-Sep VA ~ 2 .5 Mo s . Post-Sep
FEV1 (% Predicted)
 89 104
FEV1/FVC
 76% 81%
Meds
 Intermittent albuterol; ?Advair, Singulair Intermittent albuterol
§ 4.97 Rating
 10% or 30% (PEB 10%) 10%

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both assigned a 10% rating under code 6602 (asthma, bronchial). The VA initially relied on the STR in lieu of a VA exam, but subsequently confirmed the same rating based on the C&P examination described above. Board members agreed that a 10% rating was justified by the FEV-1/FVC of 76%, or by the intermittent use of inhaled bronchodilator therapy. The STR shows one prescribed course of oral steroids, which does not meet the criteria for a 60% rating (i.e. three courses required in one year). The 30% rating requires daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. In its deliberations the Board devoted ample attention to the issue of whether the requirement for daily bronchodilator and/or anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97. The Board does take the reasonable position that the evidence should satisfy an assumption that the treatment regimen supporting the higher rating is necessary to maintain good control of the condition. That question is 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 (as indicated by the pharmacy record and C&P examiner in this case). 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 (as specified in the VASRD rating language) the daily regimen. The statement by the CI at the separation physical clearly indicated that inhalers were used intermittently. The pharmacy record and STR supported the sporadic use of asthma medication; and the C&P examiner confirmed the use of intermittent bronchodilator therapy, but no daily asthma medication. Relying only on the STR, the VA declined to regard the medications as required. The Board thus concluded that the 30% criteria were not met. 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. In the matter of the asthma condition and IAW VASRD §4.97, 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 recharacterization of the CI’s disability and separation determination, as follows:

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



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130916, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20140016351 (PD201301411)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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