RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01917
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20050919

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Flight Training Monitor) medically separated for asthma.  The asthma could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS).  She was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “asthma,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “asthma” as a Category I unfitting condition, rated 10%, citing application of Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB identified two additional Category III (not separately unfit & compensable/ratable) conditions (overweight and tobacco habituation).  The CI made no appeals and was medically separated.  

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  Her complete submission is at Exhibit A.

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 20050808	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20051117	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060209 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Asthma.  The Ssrvice treatment record (STR) revealed that the CI had no pre-existing pulmonary history.  The CI developed persistent symptoms of cough, shortness of breath, and wheezing with exertional activities beginning in January 2005.  Initially her condition was treated symptomatically with short course steroids and rescue inhalers.  Multiple spirometry tests indicated mild to moderate pulmonary obstruction with evidence of bronchospasm.  The pulmonologist did not report spirometry measurements, but rather commented “spirometry was performed and conducted in my office that has been showing normal FEV l-FVC with a ratio which was slightly at the lower edge.”  She was diagnosed with bronchial asthma.  In May 2005, her medications included Albuterol (inhalational ‘non-steroid’ bronchodilator) as well as Advair (inhalational steroid/long-acting bronchodilator combination) on a daily basis.  A pharmacy profile dated August 2005 revealed that the last filled prescription for Advair was May 2005 with six refills authorized.  Her serial spirometry tests remained mildly abnormal.  Due to the inability to perform military duties, she was referred for an MEB.

At the MEB narrative summary (NARSUM) examination (15 July 2005; 2 months pre-separation), the CI reported exertional cough and wheezing for the previous 2 months.  The physical examination (PE) was normal and her listed medications were Albuterol as needed and Advair twice daily.  Asthma remained the sole diagnosis on her permanent profile and the commander’s statement noted her ability to perform duties assigned within her stated restrictions despite being non-deployable.  

At the VA Compensation and Pension (C&P) examination (17 November 2005; 2 months post-separation), the CI’s medication remained unchanged.  She endorsed asthma attacks (3-4 times per week) triggered by running and excessive exertion like climbing stairs.  She denied emergency room visits or hospitalizations due to asthma.  The VA PE remained normal.  The spirometry results as referenced above, with §4.97-ratable treatment criteria, are summarized in the chart below.  

Pulmonary Exam	MEB ~2 Mo. Pre-Sep
(20050714)	VA C&P ~2 Mo. Post-Sep
(20051117)	
FEV1 (% Predicted)	71	72	
FEV1/FVC	80	86	
Meds	Singular, Advair, Albuterol	Advair, Singular, Albuterol, 	
§4.97 Rating	30%	30%	

The Board directed attention to its rating recommendation based on the above evidence.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both spirometry derived criteria and clinical treatment criteria for rating under 6602.  Based solely on spirometry parameters the CI’s condition did meet the VASRD 10% disability criteria; and therefore in agreement with the PEB and VA ratings.  However, the clinical treatment criteria underpinning the 10% and 30% ratings are the pivotal points for recommendation in this case.  The non-spirometry derived criteria are: “intermittent inhalational or oral bronchodilator therapy” for 10%; and “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication” for 30%.  Having clear evidence of using inhaled anti-inflammatory medication (Advair) on both pre and post-service examinations easily met the 30% impairment level. 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. 

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.  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 	6602	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01917.

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 Affairs 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