RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01963
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150305
SEPARATION DATE:  20050502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Communications Computer Systems Control Journeyman) medically separated for asthma.  The 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 temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “asthma” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI demanded a formal hearing and a subsequent Formal PEB (FPEB) affirmed the decision of the IPEB.  The CI appealed the FPEB; however, the Secretary of the Air Force Personnel Counsel upheld the findings of the FPEB.  The CI made no further 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 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:

FPEB – Dated 20050121	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050818	
Other x 0 (Not In Scope)	Other x 9 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20051004 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma.  The narrative summary noted the CI was diagnosed with asthma and treated with oral bronchodilator (BD) medication, a steroid inhaler, and a combination inhaler or bronchodilator inhaler as needed.  Notes in the service treatment record (STR) indicated that the CI presented with reported palpitations, chest pain, and shortness of breath (SOB) which occurred at rest or with exercise.  Initial pulmonary function tests (PFTs) on 21 May 2003 showed a restrictive abnormality [may be seen with asthma].  The CI was evaluated by a pulmonary specialist on 23 June 2003; tests to evaluate the palpitations and chest pain (Holter monitor, an exercise stress test, an echocardiogram) were normal, except for mild mitral valve prolapse.  Asthma was diagnosed by Methacholine Challenge Testing on 9 July 2003.  The pulmonary specialist initially prescribed a daily combination (bronchodilator and steroid) inhaler (Advair) and a second combination inhaler (Combivent) as a rescue inhaler.  Later due to side effects the daily combination inhaler (Advair) was changed to daily steroid inhaler (Flovent), and an oral bronchodilator medication (Singulair) was added.  Pulmonary follow-ups indicated the CI was doing well on Flovent and Singulair, and the rescue inhaler was changed from the combined inhaler (Combivent) to a bronchodilator inhaler (Albuterol) as needed.  Primary care notes in the STR to March 2005 indicated the CI continued on the daily steroid inhaler, daily oral bronchodilator medication, with use of the rescue inhaler less than once per week.  Four PFTs were performed in September 2004, 8 months prior to separation, in preparation for the MEB.  Two PFTs dated 10 September and 13 September noted post-bronchodilator forced expiratory volume in one second (FEV1) between 56 to 70% predicted (PRED) and two earlier PFTs, dated 4 September and 9 September, noted FEV1 greater than 71% PRED.  All four PFTs showed FEV1/FVC (forced vital capacity) ratios greater than 80%.

The MEB examination on 26 August 2004, 8 months prior to separation, noted the CI was diagnosed with bronchial asthma which was much improved by treatment.  At the MEB examination, the CI reported three to five episodes per month of SOB with exercise that resolved with rest or with use of the rescue inhaler.  Listed medications were Singulair, Flovent, Combivent, and Albuterol prior to exercise.  The MEB physical exam noted normal respiratory and cardiac examinations.  Chest X-ray was normal 

At the VA Compensation and Pension (C&P) examination on 18 August 2005, 4 months after separation, the CI reported SOB one to two times per week or with exercise.  She reported asthma attacks monthly that did not require physician treatment to control and the examiner noted “she requires inhalation of anti-inflammatory medication and singulair.”  She denied frequent respiratory infections or lost time from work.  On the exam there were no respiratory or cardiac abnormalities.  Chest X-ray was normal and PFT noted a post-bronchodilator FEV1 of 76% PRED.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the asthma condition 10%, coded 6602 (asthma).  The Board reviewed the rating criteria of VASRD code 6602.  The 10% rating is specified as FEV1 of 71-80% PRED or; FEV1/FVC of 71-80%; or, intermittent inhalational or oral bronchodilator therapy.  The 30% rating is specified as FEV1 of 56-70% PRED, or; FEV1/FVC of 56-70%; or, daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.  The Board first considered the PFT evidence and noted that proximate to separation five PFT results were split between the 10% and 30% rating criteria, with the last three meeting the 10% rating.  Asthma is a condition defined by reversible bronchospasm and the fact that the last three PFTs were all slightly better than earlier PFTs may have represented improvement or may have just reflected characteristic variable bronchospasm.  For this reason the Board agreed that the PFT evidence was equivocal and in itself was insufficient to recommend the 30% rating.  The Board next considered that at the time of separation, although the CI’s asthma was relatively well controlled, treatment notes in the STR, the MEB and C&P exams consistently documented use of the anti-inflammatory inhaler and oral bronchodilator medications, with occasional need for a rescue inhaler.  Board discussions focused on whether the CI was taking daily medications at the post-separation C&P or if the condition had improved.  At both the MEB and C&P exams the CI reported continued use of a steroid inhaler and oral bronchodilator medication, but the frequency was not clearly documented.  However, treatment notes in the STR repeatedly indicated that they were prescribed daily.  Board consensus was that with resolution of reasonable doubt in favor of the CI, the evidence in record supports daily medication use for asthma at the time of separation.  Moreover, the record clearly documents the ongoing use of “inhalational anti-inflammatory medication.”  Following deliberations, Board consensus was that with consideration of VASRD §4.3 (reasonable doubt) and §4.7 (Higher of two evaluations), the evidence supports the 30% rating.  The Board reviewed to see if the next higher evaluation of 60% was achieved, but noted that it requires lower FEV1 or FEV1/FVC than present in this case or; at least monthly visits to a physician for care of exacerbations, or; at least three courses of systemic steroids per year, also not documented in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 and §4.7, 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 Condition 	6602	30%	
COMBINED	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 XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01963.

	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
DFAS-IN