RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02257
BRANCH OF SERVICE:  aIR FORCE	SEPARATION DATE:  20020819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Security Forces Journeyman, medically separated for asthma.  The Informal PEB adjudicated asthma as unfitting, rated 10%.  

CI CONTENTION:  “Please consider all conditions”

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 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 200	VA* - Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR	
Tobacco Abuse	 Cat III	No VA Placement	
Other x 0 (Not In Scope)	Other x 5	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20040521 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  
Asthma Condition.  According to service treatment records and the MEB narrative summary (NARSUM) the CI was evaluated in January 2002 (7 months prior to separation) for a recent history of recurrent exertional shortness of breath, wheezing and coughing.  A diagnosis of asthma was made based on positive methacholine challenge test and clinical presentation.  Inhaled bronchodilators (albuterol) were prescribed on an “as needed” basis and inhaled anti-inflammatory medications (Advair) were started at that time.  The condition did not respond sufficiently to treatment and he was referred for an MEB.  According to the pulmonary clinic evaluation on 28 January 2002 (7 months prior to separation) the examiner noted that the CI had been prescribed Albuterol.  The examiner stated that daily medications were required for asthma control, and instructed the CI to use Advair 250/50 twice a day and albuterol on an as-needed basis.  Pulmonary function testing (PFT) on 30 January 2002 (7 months prior to separation) showed an FEV-1 of 75% of predicted and an FEV-1/FVC of 82% (normal) and methacholine challenge test was positive with a 20-30% drop in PFT values.  PFTs returned closer to baseline following inhalational bronchodilator use.  According to the family practice clinic telephone consultation note on 22 March 2002 (5 months prior to separation), the provider increased the strength of the CI’s twice a day Advair to 500/50.  According to the MEB Narrative Summary (NARSUM) on 19 May 2002 (3 months prior to separation), the examiner noted that the CI’s current medications were Advair twice a day and albuterol inhaler twice a week.  Lung and chest exams were normal.  Review of the service treatment record (STR) showed no clinical encounters in evidence documenting the 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.  There was no VA Compensation and Pension (C&P) exam performed proximate to separation, and VA records indicated that the CI did not report for scheduled examinations.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% (coded 6602) citing DOD and VASRD guidance.  Of note, DoDI 1332.39 guidance (in effect at the time) for rating asthma focused extensively on PFT values and differed from the VASRD criteria.  The VA rated the asthma condition 0% (coded 6602) citing “a noncompensable evaluation is assigned unless there is forced expiratory volume in one second (FEV-1) of 71 to 80 percent of predicted value; or a ratio of FEV-1 to forced vital capacity of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy.”  It was agreed that “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” was not evident in the available STR.  Therefore, a 60% rating was not warranted.  There were no PFT’s in evidence which would be ratable at higher than 10%.  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members considered that the exams in evidence reported current prescription and use of daily bronchodilators and inhaled anti-inflammatories.  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.  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, coded 6602.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that tobacco abuse was not separately unfitting and not ratable.  Tobacco abuse is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting or ratable.  

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 tobacco abuse 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%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140522, 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-2014-02257.

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