RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00461
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141104
SEPARATION DATE:  20061025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (3E473/Pest Management Craftsman) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the asthma condition as unfitting rated at 10%, referencing the Department of Defense Instruction (DoDI) guidelines and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “All medical conditions were not considered.  For example my medical physician stated to me that I did not just get sleep apnea, I had it while I was active duty but because I was not test until after I was separated sleep apnea was not considered.  It has been determined that my Asthma was worse than what was assessed at the time of my medical separation.  It has been determined Anxiety disorder was related to my military service, this was not considered at the time of my medical separation.  I would like to note I signed my medical separation paper work based on information that I was given in 2006.  Had I known the severity of my situation I would have disputed my case while active duty in 2006.  I was very ill I did not know what was going on with my health.  I trusted the doctor and the airman that were handling my case.  After all the dust settled I felt cheated out of my life! I was told that I was going to be taken care of!  To this day I do not feel taken care of; I feel cheated!  I really hope my case can be rated fairly.  I feel that I should have medically retired and my family should have military I.D. I was good soldier and the military was my life!”

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; the contended sleep apnea and anxiety disorder was not documented by the PEB or MEB and is therefore not in scope.  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 20060908	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%*	20080227	
Other x 0  (Not in Scope)	Other x 0 (Not in Scope)	STR	
Rating:  10%	Combined:  30%	
*Increased from 0% to 30%, retroactive to separation, based on a post-separation examination.

ANALYSIS SUMMARY:

Asthma Condition.  The record indicates that the CI was seen in a local (civilian) emergency room on 13 September 2005 for new onset asthma.  He was advised to stop smoking and started on medications including oral and inhaled steroids.  On spirometry, he had a mild to moderate obstructive defect (asthma) with a good response to medications.  Over the course of the next year, his medications were adjusted and he was able to stop smoking with an improvement in both his pulmonary function tests (PFTs) and the use of a daily inhaler.  He continued to be on a profile limiting the use of a gas mask which rendered him non-deployable and impaired his ability to accomplish his duties in garrison as well.  The narrative summary notes that the medication regimen was being adjusted for better control even at the time of the dictation.  He was on a daily bronchodilator and anti-inflammatory.  His lungs were clear without wheezes and the PFTs are charted below.  

The CI did not report for the initial VA Compensation and Pension examination, but was evaluated on 27 February 2008 (performed 16 months after separation).  He reported daily medication use with a “rescue” inhaler 3 to 4 times a week.  He reported that most of his symptoms were well controlled and denied any “asthma attacks.”  On examination, his lungs were clear without wheezing.  No history of current tobacco abuse was recorded.  The PFTs are below.  The pulmonary evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

PFTs
Pre/Post Bronchodilator	MEB ~5 Mo. Pre-Sep	4 Mo. Pre-Sep	4 Mo. Pre-Sep	VA ~ 16 Mo. Post-Sep	
FEV1 (% Predicted)	42/56	69/92	58/71	64/74	
FEV1/FVC%	91/74	95/99	77/90	66/73	
Comments	Still smoking	Still smoking; No comment on medications	Stopping tobacco; on daily anti-inflammatory	Tobacco not recorded; daily anti-inflammatory	
§4.97 Rating	30%	10%	30%	30%	
30% rating supported by daily medication use and anti-inflammatory use.  Post-bronchodilator values support a 10% rating.

The Board directs its attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 (asthma) and rated it at 10%.  The VA’s examination, over a year after separation, used the same code, but rated the asthma condition at 30% disability, retroactive to the date of separation.  The Board noted that the medication profile supports 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.

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 although the PEB did note that it followed DoD guidelines as well.  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 re-characterized 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 20140101, 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-2014-00461.

	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