RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01262
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Security Journeyman, medically separated for “severe persistent asthma,” with a disability rating of 10%.  

CI CONTENTION:  He was given a higher rating for his asthma condition by the VA.  He was not given a rating for gastroesophageal reflux disease (GERD).  The CI’s 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 - 20050617	VARD - 20060216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Severe Persistent Asthma	6602	10%	Exercise Induced Asthma	6699-6602	10%	20050926	
Gastroesophageal Reflux Disease (GERD)	Not Unfitting	Duodenitis	7399-7305	10%	20051116	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in April 2004 for a recent history of recurrent coughing.  A diagnosis of exercise-induced asthma was made based on clinical presentation.  Inhaled bronchodilators (BD) were prescribed on an “as needed” basis and inhalational anti-inflammatory medications (Advair) were started in April 2004.  The CI was evaluated by pulmonary and had multiple pulmonary function tests (PFT) and methacholine challenge tests (MCT) with negative results for reactive airway disease.  However, notes indicated that the results may have been affected by use of inhalers proximate to the testing.  The CI stopped his medications with recurrence of shortness of breath (SOB) which was relieved by resuming use of his anti-inflammatory inhaler.  At a primary care clinic (PCC) visit on 25 March 2005, the CI reported significant increase in his SOB during allergy season and he requested repeat testing during the peak of his symptoms.  At a follow-up PCC visit on 21 April 2005 the MCT test was interpreted as positive for asthma, with a 26% decrease in FEV1 noted with challenge.  The CI was noted to be on multiple medications including anti-inflammatory and BD inhalers, oral anti-inflammatory medication, as well as medications for seasonal allergies with uncontrolled symptoms.  Continued use of the same medications was recommended.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “severe persistent asthma” for PEB adjudication.  The MEB NARSUM examination on 3 May 2005, 3 months prior to separation, noted that the CI continued on the same asthma medications listed above.  The CI reported continued use of his rescue BD inhaler several times per week, especially with exercise. The lung exam was normal, without wheezing or other abnormal sounds. 

At the VA Compensation and Pension (C&P) evaluation on 26 September 2005 (a month after separation) the examiner noted that the CI had “been given albuterol, two puffs, PRN [as needed], in addition to Advair, 500 mg, twice a day.”  A PFT was normal before BD use (FEV-1 of 82% and an FEV-1/FVC of 88% of predicted), and the pulmonary exam was normal.  Review of the STR showed no evidence documenting 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. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% coded 6602 with likely application of DoDI 1332.39 rating guidance in effect at the time, which differed from VASRD rating criteria.  The VA rated the asthma condition 10% (coded 6602) citing “use of oral bronchodilator therapy…” Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were prescribed and used, as noted by the all examiners, as well as daily oral BD use (Singulair).  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator and/or 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 and there also 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 recommended a disability rating of 30% for the asthma condition, coded 6602.  

Contended PEB Conditions.  

GERD:  The Board’s main charge is to assess the fairness of the PEB’s determination that GERD was not unfitting (Category II: a condition that can be unfitting but is not currently compensable or ratable).  A pulmonary evaluation on 10 January 2005 for symptoms of cough and SOB indicated that testing for asthma had not confirmed the diagnosis and the CI had GERD symptoms that were likely related to his cough.  Subsequently, additional testing did confirm a diagnosis of asthma.  There was no evidence in the record that the CI was further evaluated or treated by a specialist for his GERD symptoms.  The NARSUM listed a diagnosis of GERD and daily use of a medication for GERD.  The MEB did not forward a diagnosis of GERD to the PEB.  The GERD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was reviewed and considered by the Board.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance.  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 the GERD and so no additional disability rating is 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 GERD condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  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 prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140115, 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 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01262.

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