RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00551
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20070123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the asthma condition as unfitting, rated 10%, citing application of Department of Defense Instruction (DoDI) 1332.39 and the Veterans Affairs Schedule for Rating Disabilities (VASRD).   The CI made no appeals and was medically separated. 

CI CONTENTION:  He should have been given a higher rating for his condition.  His 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 20061201	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Mild Asthma	6602	30%	20070330	
Other x 0 (Not In Scope)	Other x 14	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070907 (most proximate to date of separation (DOS)).  
ANALYSIS SUMMARY:  

Asthma.  The narrative summary (NARSUM) and treatment records indicated that the CI developed coughing and wheezing with episodes of shortness of breath in 2004 during a deployment.  He was diagnosed with asthma and despite adequate bronchodilator therapy but continued to complain of cough and wheezing with exertion and when exposed to chemicals.  Pulmonary function tests (PFTs) documented moderate restrictive airway disease.  Chest X-rays had no acute pathology, but noted decreased epidiamter (narrowed chest space which can affect PFTs).  Medications included Advair (inhalational anti-inflammatory medication:  steroid/bronchodilator combination of fluticasone/salmeterol) one puff twice daily, Singulair™ (oral indirect-acting bronchodilator- montelukast) daily and Combivent (inhalational bronchodilator-ipratropium/albuterol) as needed.  The MEB physical exam noted a normal lung auscultation with no wheezing; epidiamter definitively decreased.  

At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported continued symptoms on medications of Advair one puff daily, Spiriva (inhalational bronchodilator–tiotropium bromide) one puff daily, Singulair one daily and albuterol inhaler two puffs as needed (2-3 times per week).  Lung exam was normal with no wheezes.  PFTs documented mild obstructive ventilator defect with significant improvement with bronchodilators.  Chest X-ray showed no abnormalities.  

Pulmonary Exam	MEB ~2 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
FEV1 (% Predicted)	66.7%	82%	
FEV1/FVC	87.5%	80%	
Meds	Advair BID, Singulair QD, Combivent PRN	Advair QD, Spiriva QD, Singulair QD, Albuterol 2-3/week	
§4.97 Rating	30% (PEB 10%)	30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 (asthma, bronchial) and rated at 10% citing PFT findings of FEV1/FVC being a more accurate assessment as FVC was smaller than predicted.  Of note, DoDI 1332.39 in effect at the time stressed ratings for asthma based on PFTs using a non-VASRD PFT table.  The VA used the same 6602 coding rated at 30% citing a “requirement for daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.”  

Although there were equivocal Service PFT values that may have rated up to 30%, the crux of rating in this case is medication usage.  All exams and treatment notes proximate to separation indicated the CI was taking daily inhalational and oral bronchodilator medication, as well as taking inhalational anti-inflammatory medication (Advair) on a daily basis.  No recorded PFT results would warrant higher than a 30% rating, and the CI did not have respiratory failure, prescribed courses of systemic corticosteroids, or required monthly physician visits to warrant any rating higher than 30%.  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 IAW §4.97.  

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.  As discussed above, PEB reliance on DoDI 1332.39 for rating asthma was operant in this case and the condition was adjudicated independently of that instruction by this Board.  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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Asthma	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140113, 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-2014-00551.

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