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AF | PDBR | CY2014 | PD-2014-01959
Original file (PD-2014-01959.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX   CASE: PD-2014-01959
BRANCH OF SERVICE: Army  BOARD DATE: 20150319
SEPARATION DATE: 20021002


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Medical Specialist) medically separated for asthma. The asthma could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty but was authorized to perform a modified physical fitness test (per PROFILE). She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The “moderate persistent asthma requiring daily medication/extrinsic (allergic),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions (allergic rhinitis and bilateral moderate pes planus) for PEB adjudication. The Informal PEB adjudicated “asthma” as unfitting, rated 10%, referencing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting with the PEB citing the bilateral moderate pes planus to have existed prior to service . The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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 20020731
 VA* - (~4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
ASTHMA 6602 10% ASTHMA 6602 30% 20030224
ALLERGIC RHINITIS Not Unfitting No VA Entry
BILATERAL MODERATE PES PLANUS Not Unfitting No VA Entry
Other x 0 (Not In Scope)
 Other x 2
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 30417 (most proximate to date of separation [ DOS ] ) .

ANALYSIS SUMMARY:

Asthma. The narrative summary (NARSUM) notes the CI developed allergy symptoms with difficulty breathing and wheezing in April 2001 and symptoms persisted despite episodic treatment. Notes in the service treatment record indicated the CI was seen for repeated respiratory symptoms beginning in October 2001. A note dated 27 November 2001, 10 months prior to separation, listed use of a steroid containing inhaler for asthma. An allergy consult on 12 March 2002 noted the CI had a history of allergy symptoms since childhood and had requested allergy testing. Pulmonary function tests (PFT) showed a decreased forced respiratory volume in one second to forced vital capacity ratio (FEV1/FVC) with a significant post-bronchodilator (BD) response, and normal PFT post-BD. Skin tests were positive for multiple environmental allergies, some of which were seasonal and geographical, others not. The CI was diagnosed with seasonal allergic rhinitis and related asthma. The allergist prescribed a combined bronchodilator and steroid inhaler (Advair) twice daily. The Allergy NARSUM performed on 2 April 2002, indicated the CI had been initially placed on oral steroids with a good response, but symptoms returned when the medication was tapered. The allergist noted that despite daily use of BD and steroid inhalers symptoms remained. On the DD Form 2697, Report of Medical Assessment, and the DD Form 2807, Report of Medical History, forms completed in April 2002 the CI reported medications of Advair (steroid), Albuterol (BD), Flonase (nasal inhaler), Serevent (BD), and Medrol (oral steroid). Chest X-rays on 10 April 2004 were normal. A medication profile in record to 17 June 2002 indicated the CI filled prescriptions for oral steroid and a steroid inhaler on 13 March 2002.

At the MEB examination 9 April 2002, 6 months prior to separation, the CI reported persistent asthma despite daily medication. The MEB physical exam noted the exam was unremarkable as documented on the DD Form 2808, Report of Medical Examination, on 9 April 2002. The commander statement on 2 May 2002, 5 months prior to separation, noted “she requires daily medication for her condition.”

At the VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported use of a BD inhaler with frequency not specified and with “asthma attacks” once a month due to weather or dependent on her physical activity. She denied any episodes of infection or hospitalization due to asthma. A PFT on 4 February 2002 was reported as normal and no post-BD test performed, but there was no indication whether the CI had used medication prior to the test. There was no difficulty breathing or wheezing noted on exam.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the asthma condition 10%, coded 6602 (asthma) and noted intermittent use of medication. The VA rated the asthma condition 30%, coded 6602, citing daily use of medication. The evidence in record supports that at the time of separation, BD and steroid inhalers were prescribed daily, and the CI reported daily use of asthma medications on the DD Form 2697 and DD Form 2807 forms and the allergy NARSUM specifically indicated “actual daily use” of a steroid inhaler. The medication profile documents that the CI obtained steroid medications once between mid-March and mid-June 2002, which raises a question of whether the CI was using the steroid inhaler daily. However, the 10% rating criteria of 6602 specifies intermittent use of bronchodilator medication and the 30% specifies either daily use of bronchodilator medication or simply “use of anti-inflammatory medication,” without the requirement of daily use. At the C&P exam 4 months after separation, the CI is noted to be using a BD inhaler, with no documentation of frequency. The specific noted inhaler (Albuterol) is not usually prescribed to be used daily, but is reserved as a “rescue inhaler.” However, Member consensus was that it could not be concluded from the evidence that the CI was using medication intermittently without speculation. The CI may have run out of other medications (4 months after separation) and was using the BD inhaler daily at the time. Board consensus was that the C&P exam did not clearly document the status of the CI’s asthma or her use of medications. Members therefore concluded that the C&P evidence was not sufficient to overcome the evidence of daily medications and anti-inflammatory medications documented during the MEB process, regardless of the CI’s compliance with the medications as prescribed. The CI’s PFTs were all normal after BD use, and there was no evidence of at least three courses of systemic steroids in the past year or at least monthly visits to a physician for management of exacerbations to meet the next higher evaluation of 60%. 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.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the allergic rhinitis and bilateral pes planus conditions were not unfitting. The Board’s threshold for countering fitness determinations-requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The CI was diagnosed with seasonal allergic rhinitis along with asthma at the allergy consult and prescribed a steroid nasal inhaler. The CI’s enlistment physical on 14 August 2000 noted mild, asymptomatic bilateral pes planus (flatfoot) and exam also noted mild hallux valgus and callouses on the third metatarsal joints. At a primary care visit on 3 December 2001 the CI reported painful calluses of both feet and X-rays were reported as normal. The CI was recommended to soak feet regularly and shave the dead skin off the calluses. The DD 2808 exam on 9 April 2002 noted symptomatic pes planus and referred the CI for orthotics.

The allergic rhinitis and bilateral pes planus conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards. Both were reviewed and considered by the Board. There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the allergic rhinitis and bilateral pes planus conditions and so no additional disability ratings are recommended.


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. In the matter of the contended allergic rhinitis and bilateral pes planus conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 her prior medical separation:

CONDITION
 VASRD CODE RATING
Asthma condition 6602 30%
COMBINED
 30%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140425, 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 XXXXXXXXXXXXXXX , AR20150013527 (PD201401959)
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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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