RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02367
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20021213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Electronic System, Journeyman) medically separated for asthma condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a permanent P4 profile and referred for an Medical Evaluation Board (MEB).  Mild persistent asthma was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated asthma condition as unfitting, rated 10% with cited application of Department of Defense (DoD) and Veteran’s Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The PEB also adjudicated tobacco abuse as category III (not separately unfitting and not compensable or ratable).  The CI appealed to the Formal PEB (FPEB) which affirmed the PEB finding and rating.  The CI made no further appeal and was medically separated.

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 condition 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:

Service FPEB – Dated 20021009	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20030324	
Tobacco Abuse	Category III	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 11	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20030514 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Asthma.  The MEB narrative summary (NARSUM) and treatment record indicated that the CI had onset of shortness of breath and wheezing in 2000.  He had breathing symptoms with exposure to insulation and with exercise and was diagnosis with asthma by a pulmonologist.  The CI was doing well on inhaled medications of Flovent (Fluticasone - inhalational steroid; anti-inflammatory medication) and Albuterol (inhalational bronchodilator).  He had decreased symptoms away from work on weekends or on leave.  He was switched from Flovent to Advair (Fluticasone/Salmeterol; inhalational steroid/bronchodilator combination) with good relief of symptoms.  Pulmonary function tests (PFTs) from 10 and 7 months prior to separation had normal FEV1 measurements and FEV1/FVC results between 56-70-percent of predicted.

At the NARSUM examination, dated 13 May 2002, 7 months before separation, the lung exam was normal with no wheezing.  The NARSUM diagnosis was “mild persistent asthma due to the necessity of controller medication (inhaled glucocorticoid and long-acting beta agonist).”  PFTs dated 15 August 2002, 4 months prior to separation were showed a normal FEV1 and an FEV1/FVC of 71 percent predicted.  The FPEB remarks dated 9 October 2002, 6 months before separation, indicated essentially that the CI had few symptoms (no missed work, ER visits or hospitalizations, and could exercise vigorously) and “that he has not required any Albuterol since he began using Advair in Jan 02.”  At the DD 2697, Report of Medical Assessment, dated 12 November 2002, a month before separation, the CI reported use of Advair daily and albuterol as needed.

At the VA Compensation and Pension (C&P) General exam dated 31 March 2003, 4 months after separation, the CI related a similar history with medication use of Advair and Albuterol inhalers that helped.  Lung exam, PFTs and chest X-ray were reported as normal.

The Board directed its attention to its rating recommendation based on the above evidence.  The CI had no episodes of respiratory failure, use of systemic corticosteroids, or frequent visits to a physician for asthma.  PFTs proximate to separation would rate no higher than 10% (FEV1/FVC of 71 percent predicted).  However, rating asthma is also based on medication use and the 30% rating criteria for asthma (6602) for “inhalational anti-inflammatory medication” does not require daily use.  The NARSUM, FPEB remarks, and VA C&P evaluations all indicated that the CI was taking Advair which is considered an inhalational anti-inflammatory medication.  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.  Tobacco use is a condition that does not constitute a physical disability and is not eligible for disability rating IAW DoDI 1332.38, enclosure 5.  It was appropriately adjudicated by the PEB as Category III.  However, any impact of this condition on the CI’s unfitting asthma condition was considered in the rating above.  After due deliberation there was insufficient cause to recommend a change in the PEB category III (not compensable) determination for the contended tobacco use 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 guidelines for rating asthma was operant in this case and the condition was adjudicated independently of those guidelines 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 recharacterized 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 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-2014-02367.

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