RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01617
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050415

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

CI CONTENTION:  “Attached with the Medical Board Report is the Medical Evaluation Board summary which states current medications prescribed during the evaluation and Advair 250/50 one puff per day is listed along with Proventil MDI two puffs q.i.d p.r.n.  Per CFR-2004-title 38 part 4.97 inhalational anti-inflammatory medication such as Advair shall be given a rating of no less than 30%.  Currently prescribed 2 puffs daily of Dulera.  Advair 250/50 is a combination of fluticasone propionate 250mcg and salmeterol 50mcg.  According to the American Lung Association fluticasone propionate is a[n] inhaled corticosteroid.  According to Advair's website, Advair contains both an anti-inflammatory and a long-acting bronchodilator.”  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 - 20050204	VARD - 20051028	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050903	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Asthma.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition developed slowly, and eventually resulted in an emergency room visit in July 2004.  He was initially treated with an inhaled bronchodilator (Proventil) and the symptoms resolved.  A formal diagnosis of asthma was established by a pulmonologist later in October 2004, and he was started on Advair (an inhalational anti-inflammatory and bronchodilator medication; Fluticasone/Salmeterol) twice daily and as needed.  The condition did not respond sufficiently to treatment and he was referred for an MEB.  According to the pulmonary evaluation on 3 November 2004, 5 months before separation, the examiner noted marked improvement, a normal Pulmonary Function Test (PFT) after bronchodilators.  The examiner indicated the CI was on Advair, but recommended reducing the dosage to one puff per day.  At the MEB evaluation on 6 January 2005, 3 months before separation, the examiner noted that the CI’s current medications were Advair (one puff per day) and Proventil (two puffs per day or as needed), and stated that the CI should continue with his current medications and avoid strenuous exercise in a cold environment.  Lung examination was normal and the above pulmonary evaluation was cited.  A separation physical cover note dated 17 March 2005, 1 month before separation) listed medications of Advair and albuterol.

The VA Compensation and Pension (C&P) examiner on 3 September 2005, 5 months after separation, noted a normal pulmonary function test.  The examiner recorded that the CI’s only medication was Albuterol (as needed), and that the CI had been treated with Advair for a few months.  The CI had “stopped running because it made his asthma act up.”

The Board noted that the CI’s application indicated he was taking Dulera (inhalational steroid/bronchodilator combination) in 2014.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 and rated at 10%.  The VA also coded the asthma condition as 6602 and rated at 10% from their examination 5 months after separation.  There was no evidence proximate to separation that documented the CI was not compliant with his daily use of inhalational anti-inflammatory medication (Advair), and a note a month prior to separation supported the use of inhaled anti-inflammatory medication.  The Board agreed that the CI’s use of inhalational Advair met the 30% rating criteria of use of “inhalational anti-inflammatory medication.”  The CI had not been hospitalized, had not required courses of systemic steroids, or required at least monthly visits to a physician for required care of exacerbations, or had documented PFTs that may have supported any rating higher than 30%.  After due deliberation, and in consideration of all 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:  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. 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	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140405, 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-2014-01617.

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