RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE:  PD-2013-01549
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141002
SEPARATION DATE:  20040714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (1C151/Air Traffic Controller Journeyman) medically separated for asthma.  The asthma condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The conditions, characterized as “moderate persistent asthma” and “esophageal reflux,” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “asthma associated with esophageal reflux” as unfitting, rated 10%, with likely application of VA Schedule for Rating Disabilities (VASRD) guidelines.  The PEB added the condition “overweight” and determined it to be Category III (not separately unfitting and not compensable or ratable).  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 associated with esophageal reflux 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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040528	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma associated with Esophageal Reflux	6602	10%	Mild Obstructive Airway Disease	6602	0%*	STR	
			Gastroesophageal Reflux Disease (GERD)	7307	0%	STR	
Other x1 (Not in Scope)	Other x 3	
Combined:  10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20050225 (most proximate to date of separation [DOS])
*CI failed to show for C&P exam; VARD dated 20131113 granted 30% for asthma effective the same day

ANALYSIS SUMMARY:  The MEB narrative summary (NARSUM) and commander’s statement were not available in evidence before the Board and could not be located after appropriate inquiries.  A further attempt at obtaining the relevant documentation would likely be futile and introduce additional delay in processing the case and, it is was judged by the members that the missing evidence would not materially alter the Board’s recommendations.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Asthma associated with Esophageal Reflux.  In mid-2003, the CI noted the onset of shortness of breath (SOB) when she ran, along with nocturnal heartburn once a week.  Over the next 7 months her SOB complaints were evaluated by an allergist while the heartburn was evaluated by a gastroenterologist.  The allergist noted the following history: 

“22yo female who for the last 3-4 months has noticed shortness of breath and wheezing after exercise.  No prior history of asthma or any wheezing. No fevers, cough, sinusitis, nor rhinitis. Albuterol MDI does improve her symptoms.  Shortness of breath and wheezing which start 5-10 minutes after exercise.  Symptoms have only started in the last 4 months; no seasonal pattern noted as yet. Pt has had symptoms of GERD for 2 months.  Was briefly on Prilosec, not taking now.”

The final allergy evaluation 3.5 months prior to separation contained the following excerpt:

“In September 2003, an Exercise Challenge showed no drop in FEV1; however a histamine challenge showed a 20% drop at 8mg/ml histamine.  Because the result was on the borderline of positive, and her symptoms were of relatively short duration, the opinion of the providers at that time was that they could not definitively diagnose asthma in her.  At that point it was recommended that she be followed for chronicity of her symptoms and that she would use albuterol MDI as needed.”

Also noted was that the CI could not perform her duties as an air traffic controller due to her profile/medication use.  Concurrent with her asthma evaluation was a workup of her heartburn complaints by a gastroenterologist.  The STRs note no relief of heartburn with over the counter antacids or the initial trial of a prescription medication indicated for heartburn.  The CI then underwent a gastric scope evaluation that revealed esophagitis and gastritis.  She was then prescribed a different heartburn medication that provided “good relief” of her heartburn symptoms 4 months prior to separation.  The MEB NARSUM was not in evidence for review by the Board and the CI failed to report for her VA Compensation and Pension (C&P) exam scheduled after filing the claim November 30, 2004.  The Board reviewed the C&P exam accomplished over 9 years after separation that resulted in a rating increase to 30% for her asthma condition on the subsequent VARD.  That exam documented no medication use for her asthma condition and a normal FEV1.  However, her FEV1/FVC was 70% (after a bronchodilator was given) and was determined to “most accurately reflect the veteran’s level of disability” and she was granted the 30% rating based on that result.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the asthma associated with esophageal reflux by applying code 6602 (bronchial asthma) and rated it 10% presumably based on intermittent inhalational or oral bronchodilator therapy as her baseline pulmonary function tests (PFT) were essentially normal.  The VA initially granted 0% evaluations for two separate conditions, mild obstructive airway disease and gastroesophageal reflux disease, because the CI failed to report for her initial C&P exam.  The Board initially considered if the service should have applied separate ratings for the asthma and esophageal reflux conditions.  Due to the “good relief” with the second prescription heartburn medication and the lack of evidence of duty limitation caused by the esophageal reflux, Board members agree that the esophageal reflux condition was not separately unfitting and therefore it could not be recommended for an additional disability rating.  The evidence present for review adequately documented duty limitation caused by the CI’s asthma related symptoms/medication.  Rating asthma IAW VASRD §4.97 guidelines depends on medication use and PFT results.  The CI required intermittent inhalational bronchodilators to manage her illness (no steroid medication was required) which is consistent with the 10% rating.  Additionally, her baseline and exercise PFT results were essentially normal, also consistent with the 10% rating.  Evidence remote from separation documented that although she required no medications, one of her PFT values was consistent with a 30% evaluation which she was granted effective over 9 years after separation.  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 associated with esophageal reflux 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 asthma associated with esophageal reflux 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

SAF/MRB

Dear XXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01549.

	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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

Attachment:
Record of Proceedings