RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01584
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20060203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Precision Measurement Equipment Lab) medically separated for an asthma condition.  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).  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 (IPEB) adjudicated asthma as unfitting rated 10% with cited application of DoD and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The IPEB also adjudicated a seasonal allergic rhinitis condition as Category II (a condition that is not separately unfitting and not compensable or ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  CI is asking for a review and consideration of all symptoms and conditions related to his medical discharge.  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/Naval 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 20051129	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20060519	
Seasonal Allergic Rhinitis	Cat II	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060829 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The CI’s asthma and seasonal allergic rhinitis (SAR) symptoms had significant overlap in symptoms and were evaluated together in multiple treatment and exam notes.  For clarity the history and exams will be discussed together with separate rating and fitness discussions below.

Asthma and Contended Seasonal Allergic Rhinitis (SAR) Conditions.  The MEB narrative summary (NARSUM) noted the CI PCSed (transferred) to Japan in December 2004 and had immediate increased sinus congestion and nighttime coughing.  Those symptoms were 90% improved with treatment of nasal steroids and oral antihistamine medications, but with residual nasal drip and cough.  The CI had onset of shortness of breath (SOB) after workouts.  He had one emergency department treatment in August 2005 for acute bronchospasm (chest tightness and SOB) after exercise.  The CI was started on asthma medication with relief of symptoms.  The CI had a month off of Advair (inhalational steroid/bronchodilator combination of fluticasone/salmeterol) and he had return of night cough, exertional SOB and wheezing.  He was restarted on asthma medications in September 2005 with symptom relief.  On medications of Advair 2x/day, oral Singulair (montelukast; indirect-acting bronchodilator) 1x/day, and Albuterol inhaler (inhalational bronchodilator) as needed, the CI had not needed his rescue Albuterol “for symptoms during rest activities.”  There were no documented hospitalizations or courses of systemic corticosteroids or immunosuppressive medications.

The MEB NARSUM physical exam noted normal nasal and oral exams.  There was diffuse wheezing on forced air expiration, and chest X-ray was normal.  Pulmonary function tests (PFT) from August 2005 (off of medications) documented an FEV1 of 74% predicted and FEV1/FVC of 86% predicted after bronchodilator use read as moderate restriction with significant reversibility.  PFTs from September 2005 (on Advair and Singulair) documented a slight worsening after bronchodilator use (paradoxical response) with both FEV1% and FEV1/FVC% greater than 80% predicted and were read as normal spirometry without significant reversibility.  The MEB NARSUM diagnosis was mild persistent asthma.

At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported asthma with three episodes of SOB per week while on medication of Advair twice a day and Albuterol inhaler as needed (3 times a week).  He was also taking daily Singulair and Claritin (oral antihistamine medication).  The review of systems indicated no sinus symptoms.  Chest exam was normal and PFTs indicated mild obstruction with an FEV1 of 94.8% and FEV1/FVC of 70% after bronchodilator use.  Nose and sinus exams were normal.  The diagnosis was bronchial asthma under treatment with continuing SOB with exertion.  Later VA records indicated an increased asthma rating to 30% effective in December 2007, based on exam approximately 22 months after separation and the addition of a 30% rating for chronic sinusitis effective in March 2009.

The Board directed attention to its rating recommendation based on the above evidence.  The rating criteria from DoDI 1332.39 (rescinded) differed from the VASRD rating criteria.  Both the PEB and VA rated the CI under code 6602 (Asthma, bronchial).  The CI had no evidence of respiratory failure, hospitalizations or at least three courses of high dose corticosteroid treatment for any rating above 30%.  Code 6602 list PFT; or bronchodilator use; or inhalational anti-inflammatory medication use criteria for ratings of 10% versus 30%.  In its deliberations, the members devoted ample attention to the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97.  The NARSUM, treatment record and VA C&P exam all supported that the CI was prescribed and used Advair daily.  Advair in addition to being an inhalational bronchodilator (Salmeterol) also contains an inhalational anti-inflammatory medication (Fluticasone), and would therefore warrant a 30% rating even if it (anti-inflammatory) was not used on a daily basis.  No PFTs would warrant any rating higher than 30%.  The Board adjudged that there was sufficient evidence of inhalational anti-inflammatory medication use (Advair) at the time of separation.  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.

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that seasonal allergic rhinitis (SAR) was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  SAR is frequently associated with increased asthma symptoms and any contribution to the CI’s asthma condition was considered in the asthma rating above.  The NARSUM indicated the SAR symptoms were well controlled.  The SAR condition was not profiled or implicated in the commander’s statement (who recommended return to duty) and was not addressed by the MEB.  Neither the NARSUM nor VA exam proximate to separation documented SAR or sinus symptoms that would likely interfere with duty.  Later VA exams with more severe symptoms documented were adjudged as post-separation worsening.  The condition was reviewed and considered by the Board.  There was no performance based evidence from the record that SAR significantly interfered with satisfactory duty performance.  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 contended SAR condition and so no additional disability rating is recommended.

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 likely 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.  In the matter of the contended seasonal allergic rhinitis 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.

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%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131220, 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-2014-01584.

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