RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01188
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Health Physicist, medically separated for asthma, with a disability rating of 10%.

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.   

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 Veterans Affairs Schedule for Rating Disabilities (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:   

SERVICE PEB - 20070124	VARD - 20071105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Obstructive Sleep Apnea with Uvulopalatopharyngoplasty (to
include Mild Asthma…)	6847	50%	20070629	
Obstructive Sleep Apnea Requiring use of CPAP	6847	Cat II					
Migraine Headaches	8100	Cat II	Migraine Headaches	8100	30%	20070629	
Gastroesophogeal Reflux Disease	7399-7346	Cat II	Gastroesophageal Reflux Disease (GERD) with Irritable Bowel Syndrome	7346	60%	20070629	
Irritable Bowel Syndrome	7310	Cat II					
Anxiety Disorder Associated with Depression	9413	Cat II	Major Depressive Disorder	5237	30%	20070629	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in December 2004 after an emergency room visit.  He was treated for asthma and was stable until he started mandatory fitness boot camp training in 2005.  Initially he was given Advair (inhalational steroid/bronchodilator combination), which improved his symptoms temporarily, but in the fall of 2005, he had increased symptoms and Singular (oral indirect-acting bronchodilator) was added.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “asthma” for PEB adjudication.  

The MEB also identified and forwarded five other conditions (obstructive sleep apnea (OSA) requiring use of Continuous Positive Airway Pressure (CPAP), migraine headaches, gastroesophageal reflux disease, irritable bowel syndrome, and anxiety disorder associated with depression) for PEB adjudication.  The Informal PEB adjudicated “asthma” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II - conditions that can be unfitting but are not currently compensable or ratable.  The MEB NARSUM examination on 12 August 2006, 7 months prior to separation, noted that the CI’s Advair was increased to 500/50 mg two times daily, in addition to beginning Singular at 10 mg.  

Pulmonary function testing (PFT) on 6 January 2005 (14 months prior to separation) showed an FEV-1 of 81% of predicted and an FEV-1/FVC of 80%, and on 5 September 2006 (6 months prior to separation) showed an FEV-1 of 82% of predicted and an FEV-1/FVC of 84%.  Review of the service treatment record (STR) showed no clinical encounters in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  At the VA Compensation and Pension (C&P) evaluation on 29 June 2007 (3 months after separation) the examiner noted that the CI’s symptoms improved since he moved to Idaho and he stopped most of his medication except for during "dust storms" once or twice a month when he used albuterol.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% (coded 6602) citing incompatibility with military service.  The VA rated the asthma condition 50%, coded 6847, for obstructive sleep apnea to include mild asthma.  Board members considered that the pre-separation examinations in evidence reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were also used, as noted by the MEB and pulmonary clinic examiners.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and inhalational anti-inflammatory medication use.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.  There was no PFT evidence to support 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, coded 6602.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that obstructive sleep apnea requiring use of CPAP, migraine headaches, gastroesophageal reflux disease, irritable bowel syndrome and anxiety disorder associated with depression, were not unfitting.  

Obstructive Sleep Apnea.  In December 2005, soft palate surgery and tonsillectomy were performed but did not cure the OSA condition.  A sleep study was conducted on 8 Feb 2006 with a CPAP trial, and with a diagnosis of obstructive sleep apnea syndrome moderate in severity.  However, there was no performance based evidence from the record that the CI had duty-limiting excessive daytime sleepiness or that OSA treated with CPAP significantly interfered with satisfactory duty performance; and the IPEB noted that the CPAP treatment produced normal sleep, snoring, and respiratory disturbances.  There was insufficient evidence showing that OSA was associated with any functional impairment that was not corrected by CPAP.  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 OSA condition and no additional disability rating is recommended.    

The migraine headaches, gastroesophageal reflux disease, irritable bowel syndrome and anxiety disorder were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 migraine headaches, gastroesophageal reflux disease, irritable bowel syndrome and anxiety disorder and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended OSA condition, migraine headaches, gastroesophageal reflux disease, irritable bowel syndrome and anxiety disorder, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6002	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
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-2014-01188.

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