RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-00023
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20070402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Supply Management Craftsman) medically separated for asthma rated 10%.

CI CONTENTION:  She was given a higher rating for her conditions by the VA.  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 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 20070214	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20070511	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 23 	
RATING:  10%	COMBINED RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20071217 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Asthma.  The service treatment record (STR) and narrative summary (NARSUM) documented breathing issues that began in April 2005 (2 years pre-separation), initially evaluated and treated with bronchodilators.  Pulmonary function testing was performed in July 2005 (21 months pre-separation) and documented “possible obstructive lung defect” with positive response to a bronchodilator.  At an allergist consultation in July 2005, pulmonary function testing documented significant small airway disease with evidence of obstructive disease, and a 12% improvement after bronchodilator therapy, confirming the diagnosis of moderate persistent asthma.  The examiner prescribed an anti- inflammatory medication (Pulmicort) for use twice daily.  At follow up visits with the allergist in August 2005, and March and June 2006, the anti-inflammatory medication was refilled or continued.  At clinic visits in August and November 2006, and February 2007, the continued use of the anti-inflammatory medication (Pulmicort) for asthma was documented.  

At a separation physical exam dated 21 March 2007, a month prior to separation, the CI denied shortness of breath, cough, and chest pain.  The examiner documented a clear lung exam without wheezing.  There was no STR documentation of any courses of systemic (oral or parenteral) corticosteroid prescriptions.  There was no STR documentation of asthma exacerbations frequent enough to require monthly visits to a physician in the year prior to separation.  There was no documentation of pulmonary function testing with an FEV-1 (forced expiratory volume in one second) of 40 to 55% predicted or FEV -1/ FVC (ratio of FEV-1 to forced vital capacity) of 40-55%.  

The MEB NARSUM exam was performed on 1 December 2006 (4 months pre-separation).  The CI reported use of her bronchodilator 4-6 times per week, prior to exercise, and that her exercise tolerance was improved since the addition of her inhaled anti-inflammatory medication (Pulmicort).  The examiner documented that her medication profile consisted of Pulmicort, one puff twice daily, and a bronchodilator.  The examiner documented a clear lung exam without wheezing and no other physical findings of asthma.  

At the VA Compensation and Pension (C&P) exam performed on 11 May 2007 (1 month post-separation), the CI reported that the condition had no impact on her activities of daily living, routine chores, sports and recreational activities or physical occupational tasks.  Her medication list included Pulmicort twice daily and a bronchodilator as needed.  The examiner documented a normal lung exam that was “effortless and within normal limits,” with normal breath sounds throughout.  There was no documentation of wheezing.  Pulmonary function testing performed at the visit documented “normal spirometric findings.”  Radiographs of the chest were normal.  The examiner diagnosed “asthma, controlled with medication, as needed.”  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6602 code (asthma, bronchial).  The VA assigned a 30% rating using the 6602 code, citing use of a bronchodilator.  There was no STR evidence of intermittent courses of systemic (oral or parenteral) corticosteroid; no evidence of monthly visits to a physician for required care of exacerbations; and no documentation of pulmonary function testing with an FEV-1 or FEV -1/ of 40-55 % in support a 60% rating.  There was clear evidence of current prescriptions for, and usage of, inhalational anti-inflammatory medication to support a 30% 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, coded 6602.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the menorrhagia condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability ratings are recommended.  

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 §4.100.  In the matter of the contended menorrhagia condition and IAW VASRD §4.116, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

The Board therefore 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 20131220, 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 XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00023.

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.

Sincerely,

Attachment:
Record of Proceedings

cc:
SAF/MRBR 
DFAS-IN