RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00309
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140910
SEPARATION DATE:  20030709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (1C052/Operations Resource Management) 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 permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as “mild intermittent asthma,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “asthma” as unfitting, rated at 10% citing criteria of Department of Defense Instruction (DoDI) 1332.39 and Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (not in evidence) which upheld the IPEB adjudication.  The CI then appealed to the Secretary of the Air Force Personnel Council which upheld the previous 10% adjudications.  She 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 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; 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 20030130	VA - (1 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma Like Condition	6602-6699	10%	Bronchial Asthma	6602	10%	20030822	
Other x 0 (Not in Scope)	Other x 3 (Not in Scope)		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20030907 (most proximate to date of separation).

ANALYSIS SUMMARY: 

Asthma-Like Condition. The CI presented to a primary care provider on 12 July 2002 with a 1-year history of periodic shortness of breath (SOB) which first manifested itself while she was pregnant.  She was referred to pulmonary medicine and underwent a methacholine challenge test (a provocative test for asthma) which was positive.  The examiner noted that the CI’s baseline pulmonary function tests (PFT) were normal and returned to 95% of baseline following administration of a bronchodilator (given to reverse the effects of the methacholine.)  She was referred for an MEB after acquiring a permanent profile which restricted the CI’s deployment status.  At her final clinical appointment, the CI stated that she was using an anti-inflammatory agent inhaler twice a day.  The narrative summary (NARSUM) dated 18 December 2002 (approximately 6 months prior to separation), the examiner noted that the CI used her anti-inflammatory agent inhaler twice a day and a bronchodilator inhaler twice a week, the pulmonary examination was normal without wheezes and her respiratory rate was 16.

At the VA Compensation and Pension (C&P) examination (performed a month after separation) the CI, who was 5-6 months pregnant at that time, reported weekly asthma attacks and the use of her anti-inflammatory agent and bronchodilator inhalers.  The examiner also noted inspiratory and expiratory wheezes while auscultating the CI’s lungs.  Even though, there were PFT evaluations in evidence, those obtained while the CI was on active duty status the dated was omitted and those obtained by the VA were performed while the CI was 5-6 months pregnant.  However, the Board did note that the pulmonologist did documented normal baseline PFTs at the time of the methacholine challenge test.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 10%, coded under 6602 as did the VA.  The VA later raised its rating to 60% (effective 28 December 2004) based on the C&P respiratory examination dated 23 February 2005.  The rating for asthma is either based on PFTs or the use of medication.  The Board noted that the pulmonologist interpreted her PFTs as normal at the time of the methacholine challenge test.  However, the probative value of the other tests was reduced by either the omission of a date or the CI’s advanced pregnancy.  Nonetheless, the used of an anti-inflammatory agent on a daily basis was clearly documented both prior to and post-separation, which supports a rating of 30%.  After due deliberation, consideration of all 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 §4.100.  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 her 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 20140108, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00309.

	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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN