RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01913
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20060626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aircraft Armament System Journeyman) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a 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 asthma as unfitting, rated 10%, with application of the US Department of Defense Instruction (DoDI) 1332.39/Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition(s) were determined to be Category II and III.  The CI made no appeals and was medically separated.   

CI CONTENTION:  “Please consider all condition.”  

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 20060511	VA* - (~05 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	Private Treatment Records
20060116	
Gastroesophageal Reflux Disease	CAT II	Hiatal Hernia, GERD Status Post Nissen Fundoplication	7399-7346	10%	STR	
Tobacco Habituation	CAT III	Not Addressed	
Other x 0 (Not In Scope)	Other x 2 	
RATING:  10%	RATING: 40%	
*Derived from VA Rating Decision (VARD) dated 20140226 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Asthma Condition.  The service treatment record (STR) documented dyspnea (shortness of breath) on exertion that continued despite maximal therapy for reflux.  Consultation with a specialist in October 2005 (8 months prior to separation) and pulmonary function testing (PFT) in November 2005 revealed a forced expiratory volume (FEV1) of 65% consistent with a diagnosis of asthma.  Further testing (methacholine challenge) on 18 January 2006 also confirmed the diagnosis (FEV1 of 89%; positive methacholine challenge; improved FEV1 after bronchodilator challenge).  At a follow up visit with the pulmonologist (dated March 2006; 3 months prior to separation), the CI reported that, since the initiation of his inhaled anti-inflammatory medications, his “quality of life had significantly improved,” and his dyspnea was completely resolved.  Evaluations for heart defects (stress and bubble echocardiograms) and other lung conditions (shunt study) were normal.  The examiner documented a normal chest and lung exam.  

The MEB narrative summary exam was dated 19 April 2006 (2 months prior to separation).  The CI reported that his shortness of breath started when he began working on the flight line with exposure to jet fields.  Since starting his anti-inflammatory medication, his symptoms improved and he was using his bronchodilator “twice a day, as necessary.”  The examiner documented a normal lung exam and referenced pulmonary function testing performed in January 2006.  He concluded that the CI’s asthma was “stable and well-controlled on anti-inflammatory medication, requiring approximately 2 puffs a day of his [bronchodilator].  It [was] apparent that working on the flight line exacerbated his asthmatic symptoms.”  On the MEB DD Form 2697 Report of Medical Assessment, dated 31 May 2006, a month prior to separation, the CI reported taking anti-inflammatory medication for his asthma.  

There was no VA Compensation and Pension (C&P) exam documentation in evidence.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the asthma as unfitting and rated 10% coded 6602 (asthma, bronchial).  The VARD in evidence indicated that a 30% disability rating had been assigned for his asthma, retroactive to the date of separation.  There was STR evidence of inhalational anti-inflammatory medication use in the 3 months prior to separation that would support a 30% rating.  There was no evidence of an FEV1 of less than 55% predicted.  There was no evidence of intermittent courses of systemic steroid use.  There were no monthly visits to a physician for required care of exacerbations to support a higher than 30% 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.  

Contended PEB Conditions.  The Board’s main charge was to assess the fairness of the PEB’s determination that the gastroesophageal reflux disease (GERD) was not unfitting.  The Board’s threshold for countering fitness determinations required a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The GERD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that the GERD 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 GERD and so no additional disability rating was 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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 gastroesophageal reflux condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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, Bronchial	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, 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-2014-01913.

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