RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02369
BRANCH OF SERVICE: AIR FORCE	BOARD DATE:  20140916
SEPARATION DATE:  20051011

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (3A0X1/Information Management) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “asthma” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  Three additional conditions, charted below, were adjudicated by the PEB as Category II (can be unfit, but not compensable/ratable).  The CI made a written appeal, which was reviewed by Secretary of the Air Force Personnel Council which resulted in no change to the PEB findings.  The CI was then 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting asthma condition is addressed below.  Additionally, the seasonal allergic rhinitis, migraine headaches and gastroesophageal reflux disease (GERD) conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20050830	VA - (1 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20051122	
Seasonal Allergic Rhinitis	CAT II	Allergic Rhinitis	6522	0%	20051122	
Migraine Headaches	CAT II	Migraine Headaches	8100	30%	20051110	
Gastroesophageal Reflux Disease (GERD)	CAT II	Gastroesophageal Reflux Disease (GERD)	7399-7346	10%	20051110	
Other x 0 (Not in Scope)	Other x 2 (Not in Scope)	20051110	
Combined:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20060106 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma Condition.  Available treatment records document that the CI was treated on 20 March 2003 for occasional left-sided chest pain and upper back pain for one week.  Running and push-ups increased the pain.  Examination of the lungs showed good air movement and no wheezing.  She denied a history of asthma but reported she had chest pain that felt like something sitting on her chest prior to enlistment.  X-rays were clear and electrocardiogram was negative.  A diagnosis of costochondritis (inflammation of the cartilage that connects a rib to the breastbone) was rendered and treated with various medications including Celebrex, Naprosyn and Motrin.  Shortness of breath and pain was present with exercise and exposure to cold air.  By April 2004 she was evaluated by pulmonary and cardiology with no pathology identified.  Pulmonary function tests (PFTs) were normal in November 2003.  Evaluation for exercise induced asthma ensued after she reported many episodes of bronchitis since she was a young child.  At that time she had wheezing with running that she thought was normal.  A diagnosis of asthma was rendered in December 2004 and CI began treatment with Albuterol and Advair.  Repeat PFTs dated 16 December 2014 were consistent with exercise induced asthma with significant reversibility after bronchodilators.  She received a P4 profile and was referred for an MEB.

The narrative summary (NARSUM) asthma addendum dated 13 June 2005 noted the CI’s symptoms occurred mainly with exercise and walking upstairs.  Symptoms increased when she was outside and especially with exposure to wind and dust.  She reported cough, wheezing or chest tightness when she was active.  Medications for her allergies included Intal (2 puffs twice daily), Albuterol (2 puffs before and after exercise), Advair 250/50 mcg (1 puff daily), Singulair (10 mg daily) and Flonase (twice daily).  Physical examination noted moderate to severe congestion of the nose bilaterally.  Breath sounds were clear and no wheezing was present; remainder of examination was unremarkable.  PFTs dated 13 June 2005 revealed continued exercise-induced asthma.  Baseline FEV1 (forced expiratory volume) and FVC (forced vital capacity) showed normal values of 2.94 and 3.51, 109% and 117% of predicted, respectively.  After exercise, FEV1 fell to 2.29 or 85% of predicted and FVC of 2.76 or 92% of predicted, representing significant obstruction.  After 5 minutes, FEV1 fell further to 2.07 or 77% predicted.  Reversibility with bronchodilators was not demonstrated, possibly due to timing of repeat PFTs after inhaled bronchodilator.  The diagnoses of allergic rhinitis, exercise-induced asthma and GERD were rendered.  She was given a prescription for a peak flow meter to check these parameters on a regular basis to determine her baseline values.

The NARSUM dated 17 July 2005 noted medications included Advair (discus 250/50mcg twice a day), Albuterol (2 puffs every 4-6 hours as needed), intal inhaler (2 puffs four times a day), Claritin (10 mg daily), and Flonase nasal spray (one spray in each nostril daily).  NARSUM noted that the asthma condition did not exist prior to service.

At the VA Compensation and Pension Respiratory examination performed a month after separation, the CI reported shortness of breath on hills and stairs, productive cough and rare wheezing.  She reported she had never smoked.  PFTs were repeated.  FEV1 prebronchodilator was 2.76, 97% of predicted and postbronchodilator was 2.26, 79% of predicted.  FEV1/FVC was 82% prebronchodilator and 87% postbronchodilator.  The physician opined that testing effort overall was adequate but FVC and FEV1 postbronchodilator scores were low because of poor effort.  There was no evidence of obstruction or restriction.  Medications included Albuterol, Serevent and Qvar.

The spirometry evaluations (tests of pulmonary function) in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated asthma as unfitting with a service disability rating of 10%, coded 6602.  The VA rated the asthma, condition 10%, coded 6602, IAW VASRD§ 4.100.  The Board considered whether criteria for a higher than 10% rating criteria had been met.  The NARSUM documented that CI received daily bronchodilator and inhalation therapy, meeting criteria for a 30% disability 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 Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that seasonal allergic rhinitis, migraine headaches, and GERD were Category II, conditions that in the Air Force are not compensable or ratable.  The Board unanimously agrees that these three conditions are not separately unfitting and are all related to the unfitting asthma condition.  All evidence considered, there is not reasonable doubt in the CI’s favor supporting reversal of the PEB fitness adjudication for any of these three conditions.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The seasonal allergic rhinitis, migraine headaches, and GERD were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  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 seasonal allergic rhinitis, migraine headaches, and GERD conditions and so no additional disability ratings are 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.  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  In the matter of the contended allergic rhinitis, migraine headaches, and GERD conditions, the Board unanimously recommends no change from the PEB determinations 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 recharacterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Asthma Condition	6602	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-02369.

	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,

							
XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings