RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX          		                   BRANCH OF SERVICE: air force
CASE NUMBER:  PD1100766		                          SEPARATION DATE:  20050509
BOARD DATE:  20120308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Staff Sergeant/E-5 (3M071 / Services Craftsman), medically separated for asthma.  The CI was diagnosed with bronchitis and reactive airway disease (RAD) in May, 2002, and was diagnosed with severe persistent asthma in July 2004.  Her baseline pulmonary function studies (PFTs) were normalized and her asthma was under good control on daily low dose inhaled steroids, leukotriene receptor antagonists and rescue bronchodilators.  She was able to tolerate exercise without symptoms; however, in    September 2004, she was issued a P4 profile which disqualified her for world wide deployment and underwent a Medical Evaluation Board (MEB).  Asthma was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AFI 48-123.  No other conditions appeared on the MEB’s submission.  Other conditions included in the Disability Evaluation System (DES) packet will be discussed below.  The PEB adjudicated the asthma condition as unfitting, rated 10%, with application of DoDI 1332.39; additionally, a history of tobacco abuse and being overweight were listed as category III conditions that are not separately unfitting or compensable.  The CI appealed for retention to the Formal PEB (FPEB), and to the Secretary of the Air Force Personnel Council (SAFPC) which upheld the unfit (at 10%) PEB adjudication.  The CI was then medically separated with a 10% combined disability rating.

CI CONTENTION:  “My rating was 10% at the time of discharge, so was medically discharged, but later it was proven to be 30% based on my service records.  I am requesting a medical retirement instead of a medical discharge since my disability has been proven to be at 30% at the time of my discharge.”

RATING COMPARISON:  

SAFPC Decision – Dated 20050329	VA (3 Mo. After Separation) – All Effective Date 20050510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20050811	
Tobacco Abuse	Category III	No Corresponding VA Entry	
Overweight	Category III	No Corresponding VA Entry	
↓No Additional MEB/PEB Entries↓	0% x 5 / Not Service Connected x 10	20050811	
Combined:  10%	Combined:  30%	

ANALYSIS SUMMARY:  The service determination of unfit for the asthma condition was considered administratively final.  

Asthma Condition.  There was no evidence for respiratory failure, frequent exacerbations requiring physician intervention, daily use of high dose corticosteroids or immune-suppressive medications, or frequent use of systemic corticosteroids.  Therefore the higher 60% or 100% ratings IAW 6602 criteria are not supported.  The PFTs were near normal following stabilization on medications and would rate no higher than 10% rating on PFT measurements alone.  The treatment criteria underpinning the 10% and 30% ratings are the pivotal points for decision in this case.  The 10% rating requires “intermittent inhalational or oral bronchodilator therapy;” the 30% rating requires “daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.”  

The narrative summary (NARSUM) indicated “she is currently being managed on triple therapy with Singulair, Pulmicort, and albuterol.  She is doing better with this regimen and is using less albuterol now,” and “her asthma is controlled with inhaled steroids, leukotriene receptor antagonists and bronchodilators.  Her current asthma can be classified as moderate persistent.”  The FPEB remarks indicated “has had no difficulties although she is currently taking two medications (Singulair & Pulmicort) for her condition.”  The Department of Veterans’ Affairs (DVA) Compensation and Pension (C&P) exam, three months  after separation stated, “she uses Albuterol rescue inhaler two puffs once a week.  Pulmicort inhaler two puffs twice daily and Singulair 10 mg at bedtime.”  

The service’s 10% rating was IAW DoDI 1332.39, para. E2.A1.2.12, which did not mirror VASRD criteria for rating asthma and is not applicable to PDBR adjudication.  All evidence proximate to separation clearly established that the CI was prescribed and was using daily inhalational therapy meeting the VASRD 30% criteria.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation rating of 30% for the asthma condition.

Other PEB Conditions.  Tobacco abuse and overweight were category III conditions which are not physical disability conditions and not compensable IAW DoDI 1332.38.  

Remaining Conditions.  Other conditions identified in the DES file were genital herpes, hemorrhoids, hyperplastic colon polyps, nausea, vasovagal syncope/anxiety and asymptomatic mitral valve proplapse.  Several additional non-acute conditions or medical complaints were also documented.  None of these conditions were significantly clinical during the MEB period, none carried attached profiles, and none were implicated in the commander’s statement.  These conditions were reviewed by the action officer and considered by the Board.  It was determined that none could be argued as unfitting and subject to separation rating.  No other conditions were service-connected with a compensable rating by the VA within 12 months of separation or contended by the CI.  The Board therefore has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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.  As discussed above, PEB reliance on DoDI 1332.39 for rating asthma was operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the asthma condition, the Board unanimously recommends a permanent service disability rating of 30%, coded 6602 IAW VASRD §4.97.  The Board unanimously agrees that there were no other conditions eligible for Board consideration which could be recommended as additionally unfitting for rating at separation.

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 her prior medical separation:

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110905, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD  20762

Dear XXXXXXXXXXXXXX

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2011-00766.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Administration Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

	As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.  

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

PDBR PD-2011-00766

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to XXXXXXXX, is corrected to show that:

		a.  The diagnosis in her finding of unfitness for Asthma, VASRD code 6602,  was rated at 30% rather than 10%.

		b.  On 8 May 2005 she elected not to participate in the Survivor Benefit Plan.

		c.  She was not discharged on 9 May 2005; rather, on that date she was released from active duty and on 10 May 2005 her name was placed on the Permanent Disability Retired List.