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AF | PDBR | CY2014 | PD-2014-01508
Original file (PD-2014-01508.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        CASE: PD -20 1 4 - 0 1508
BRANCH OF SERVICE: MARINE CORPS   BOARD DATE: 201 5 0121
Separation Date: 20081230


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Infantry Rifleman) medically separated for asthma. This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occup ational Specialty or physical fitness standards, so he was placed on limited duty ( LIMDU ) and referred for a Medical Evaluation Board (MEB). The CI submitted a rebuttal to the MEB findings, but it was denied, and the asthma condition, characterized as “extrinsic asthma without mention of status asthmaticus , ” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E (along with four other conditions that the MEB identified) for adjudication. The PEB adjudicated “asthma, moderate” as unfitting, rated 30%, but also implemented a 20% deduction for non-compliance, which brought the disability rating to 10%. The PEB also adjudicated the posttraumatic stress disorder and a llergic r hinitis as Category II I conditions ( Conditions that are not separately unfitting and do not contribute to the unfitting condition ) and B enzodiazepine dependence and alcoholism as Category IV conditions (“Conditions which do not constitute a physical disability”). The CI made no further appeals and was medically separated.


CI CONTENTION : “During the time of my board, my ex-wife pestered my command until it was unbearable to remain in the service due to the politics of my bosses. The medical officer stated I was not taking my meds which was untrue in order to effect a quick resolution of my med board which if I recall first was first %20 until it was lowered due to the medical officers statement. At the time I was pressured to get the board resolve so I could be processed for discharge. Due to my command pressure and work climate I signed the boards findings and did not challenge them so I could be done with it and separated from service. The final rating was %10.” [sic]


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 Veterans Affairs Schedule for Rating Disabilities (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 :

Service PEB – Dated 20080811
 VA - (7 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma, Moderate 6602 10%* Asthma 6602 30% 20090731
Other x 4 (Not In Scope)
 Other X 11
Combined: 10%
 Combined: 60%
Derived from VA Rating Decision (VARD) dated 20091014 * 20% reduction by PEB for non-compliance
invalid font number 31502

ANALYSIS SUMMARY :

Moderate Asthma Condition . The CI developed breathing difficulties in 1996 while at Camp Pendleton , C A . He was started on an A lbuterol inhaler and advised to take this before and during exercise , if necessary. The inhaler helped to reduce his symptoms, but did not completely resolve them. In 2000, a t Camp Lejeune, NC , t he CI was diagnosed with repeated episodes of bronchitis whenever he would try to exercise and would be given antibiotics and A lbuterol on a whenever necessary basis . When the CI w as deployed, he was running and passed out. After the CI redeployed, he was evaluated for exercise induced asth ma. A pulmonary function test demonstrated airflow obstruction that was moderate in severity with an FEV1 of 69% predicted . The examiner further documented that the borderline results satisfied the American Thoracic Society criteria for a bronchodilator response with a 12% increase in FEV1. The p rimary c are p rovider (PCP) noted that the CI had an episode of nocturnal wheezing and that he was compliant with the Flovent (steroid inhaler) and A lbut erol inhaler s . In July 2006, the PCP stopped the Flovent inhaler and changed the medication to Advair 250/50 twice daily, and added Singulair and an allergy medication. The primary care clinic ( PCC ) noted that the CI reported shortness of breath, wheezing and chest pain with exertion, stair climbing and running a few steps and diagnosed an upper respiratory infection. The examiner documented that the CI was actively taking all prescribed medications . The Allergist also noted that the CI was taking his Advair and Albuterol. The CI underwent extensive allergy testing and was diagnosed with allergic rhinitis and exercise induced asthma . The examiner advised a change from Claritin to Zyflo and to continue Advair. The p ulmonologist documented that the CI reported dyspnea on heavy exertion which was responsive to Albuterol, and a mild intermittent nonproductive cough with a normal chest exam. The examiner noted active daily medications of Floradil (bronchodilator), Singulair, Asmanex (inhaled steroid), Nasonex and Claritin. The n on- m edical assessment documented that the CI was currently complying with all treatment although he had a past history of noncompliance . The PCC noted that the CI was actively taking his Advair daily and the pulmonary exam was normal, no wheezes or rhonchi in the lungs were not ed. The MEB narrative summary exam approximately 8 months prior to separation documented that the CI was non-compliant with his care during his second LIMDU period. The examiner noted that the CI was placed on Advair, Albuterol , Singulair, Ipratropium ( anticholinergic drug ) and two allergy medications. The lung exam was normal. T he VA Compensation and Pension exam performed approximately 7 months after separation documented that the CI was actively using two inhalers. The CI also reported that cold air and running precipitated wheezing. The pulmonary exam was again normal.

The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the a sthma, m oderate condition as 6602 and rated at 10 %. The PEB initially rated the a sthma condition at 30%; however , the PEB applied a 20% reduction for non-compliance . The VA used the same coding for the a sthma condition and rated at 30%. T here is clear documentation that the CI was prescribed and was actively taking his Advair and Albuterol inhalers daily. Additionally, the 30% rating criteria is warranted by even episodic use of inhalational anti-inflammatory medication (Advair). 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 a sthma, m oderate 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 m oderate a sthma condition, the Board unanimously recommends a disability rating of 30 %, coded 6602 IAW VASRD §4.10. 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
Moderate Asthma 6602 3 0%
COMBINED
 3 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 140330 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









                                                              
XXXXXXXXXXXXXXXXXXXX
President
DoD 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 15 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(c) PDBR ltr dtd 9 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(d) PDBR ltr dtd 29 May 15 ICO XXXXXXXXXXXXXXXXXX

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.       XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 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 complete.



XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)



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