RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01979
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5 (Materiel Management Craftsman) medically separated by the Informal Physical Evaluation Board for “asthma” with a disability rating of 10%.

CI CONTENTION:  Her condition continues to worsen and negatively impacts her daily activities.  Her 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 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 - 20071120	VARD - 20080410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Exercise Induced Asthma	6602	30%	20080204	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY: 

Asthma Condition.  The CI was evaluated in July 2006 for a recent history of recurrent chest tightness, wheezing and coughing.  A diagnosis of asthma was later rendered by a pulmonologist.  At an outpatient visit on 12 September 2007 (4 months prior to separation), the CI reported compliance with her inhaled anti-inflammatory medication (Advair), an oral bronchodilator (Singulair), and an inhaled bronchodilator (Albuterol).  PFT results showed an FEV-1 of 84% of predicted and an FEV-1/FVC of 86%.

According to the MEB Narrative Summary (NARSUM) evaluation on 5 October 2007 (3 months prior to separation) the CI was on Advair twice daily, Singulair daily, and Albuterol as needed.  A periodic health assessment on 22 October 2007 reported that the CI was “taking steroids for asthma.”  Review of the service treatment record found no requirements for systemic corticosteroids for asthma or for use of other immunosuppressive drugs during the year prior to separation.

At the VA examination on 4 February 2008 performed a month after separation, the CI reported that she needed to see “a physician to control the attacks as often as six times per year.”  The examiner noted that the CI was on inhaled anti-inflammatory medication, an inhaled bronchodilator medication daily, and an oral bronchodilator medication daily.  Reference was also made to “immunosuppressive medication.”  PFT results showed an FEV-1 of 90% of predicted and an FEV-1/FVC of 79%.  The examiner considered the exercise-induced asthma to be “controlled with medications.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6602 code (asthma).  The VA assigned a 30% rating using the 6602 code (asthma) citing required use of immunosuppressive medication, an inhaled anti-inflammatory medication, an inhaled bronchodilator medication, and an oral bronchodilator medication on a daily basis.  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members considered that the MEB and VA C&P exams reported current prescription and use of daily bronchodilators and inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement.  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/or inhalational anti-inflammatory medication use.  Requirements for the next higher 60% rating [FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids] were not in evidence.  There likewise was no evidence of immunosuppressive medication use as stipulated under the 100% rating criteria.  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.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  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%	
RATING	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/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-2014-01979.

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