RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01970
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140801
SEPARATION DATE:  20051026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty TSGT/E-6 (6F071/Financial Management and Comptroller) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “mild to moderate persistent asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “asthma, mild to moderate, persistent” as unfitting, rated 10%.  The IPEB also added “seasonal allergic rhinitis” and “gastroesophageal reflux disease” as Category II conditions that are conditions that can be unfitting but are not currently compensable or ratable.  The IPEB also added “overweight” and “hyperlipidemia” as Category III conditions which are conditions that are not separately unfitting, compensable or ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “When I received my evaluation from the Med Board and saw 10% I asked why it was so low since I was being separated--no one could answer. The VA re-evaluated me to a higher percentage.”

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 condition is addressed below; and, 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 20050708	VA - (7 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Mild to Moderate, Persistent	6602	10%	Obstructive Airway Disease	6699-6602	30%	20060506	
Other x 4 (Not in Scope)	Other x 9	20060506	
Combined:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20060907 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  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 VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Asthma Condition.  After presenting for emergency care for shortness of breath (SOB) in 2004, a diagnosis of asthma was made.  Formal pulmonology evaluation subsequently ruled out other lung diseases.  Review of the service treatment record showed that Advair (an inhaled bronchodilator-steroid combination) was first prescribed in August 2004 and continued indefinitely.  Except for one course of an oral steroid (prednisone) prescribed by a pulmonologist in April 2005 to assist in diagnostic clarification, there was one other steroid course for an asthma exacerbation in evidence during the year prior to separation.

The narrative summary on 12 May 2005 (5.5 months prior to separation) reported that the CI’s baseline asthma symptoms improved with the use of inhaled medications and that he was able to return to exercise by pre-medicating with Albuterol (inhaled bronchodilator).  Current medications included Albuterol as needed for SOB and Advair twice daily.  Physical exam was remarkable for mild bilateral expiratory chest wheezes.  The examiner (a pulmonologist) advised that the above medications be continued.  At the VA Compensation and Pension (C&P) exam on 6 May 2006 (6.5 months after separation), the CI reported missing about one day of work per month and left work early on a few occasions due to his lung problem.  Current medications included Albuterol and Advair.  Examination detected rare chest wheezes.

The pulmonary function evaluations (PFT) in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Pulmonary Exam	Pulm ~8 Mos. Pre-Sep	Pulm ~6 Mos. Pre-Sep	VA ~7 Mos. Post-Sep	
FEV1 (% Predicted)	71	100	59	
FEV1/FVC	79%	75%	74%	
Meds	Proventil, Advair	Proventil, Advair	Albuterol, Advair	
§4.97 Rating	30%*	30%*	30%**	
		*Based on medication
	                     **Based on medication and PFT

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 10%, coded 6602, while the VA assigned a 30% rating under the same code (analogously).  The service PFT data warranted a 10% rating while the C&P PFT results supported a 30% rating (FEV-1 of 56- to 70-percent predicted).  However, a 30% rating also stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members agreed that the requirement and use of inhaled anti-inflammatory medication (Advair) in this case clearly met the VASRD §4.97 threshold for a 30% rating.  There was no evidence of frequent visits for care of exacerbations or of sufficient courses of systemic steroid use to justify the next higher 60% rating.  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.  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 recharacterized to reflect permanent disability retirement, effective as of the date of his 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 20131028, 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 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01970.

	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