RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02717
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20030421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Vehicle Operations Journeyman, medically separated for “asthma” with a disability rating of 10%.

CI CONTENTION:  Condition continues to worsen and negatively impact his daily activities.  The CI’s 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 Physical Evaluation Board (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 based upon a 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 - 20030221	VARD - 20031008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma symptoms began in April 2001.  The CI lived in Okinawa near the ocean and the coral dust was believed to affect his breathing.  Treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded asthma for PEB adjudication.  According to the pulmonologist consult on 10 January 2003 (3 months prior to separation) the examiner noted that the CI was taking Albuterol as needed.  A spirometry was done which was noted to be normal with the exception of slightly low vital capacity at 79% of predicted.  FEV1 was 87% of predicted.  The examiner felt the CI had a pretty severe bronchial reactivity and needed to be on anti-inflammatory medications (Pulmicort (inhalational steroid), Albuterol as needed).  At the 24 January 2003 follow-up, the CI reported his breathing was better and was only using the Pulmicort.  His use of the Albuterol was much less “once a day at most, occasionally none.”  The MEB NARSUM examination on 6 February 2003, 3 months prior to separation, noted improvement of shortness of breath, chest tightness, wheezing and a cough with use of Pulmicort.  The lung examination was normal.  The examiner noted markedly improved symptoms with initiation of Pulmicort.  The VA did not conduct a Compensation and Pension (C&P) evaluation and used available service treatment records.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma condition 10%, coded 6602 based on service treatment records, citing FEV-1 of 76 percent and use of an inhaler. Board member agreed that the evidence support a 30% for inhalational anti-inflammatory medication.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% rating.  Review of the STR found 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.  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.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  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 of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on   Case Number PD-2014-02717

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended the separation be re-characterized to reflect permanent disability retirement with a combined disability rating of 30% rather than 10%.

I have reviewed the application and Record of Proceedings and I recommend you accept this proposed decision.

As a reminder, a copy of your decisional documents must be provided to the PDBR at the following address:

	Sincerely,

Attachments
1.  Record of Proceedings
2.  Case File