RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02837
BRANCH OF SERVICE:  Air force 		SEPARATION DATE:  20051017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Survival, Evasion, Resist and Escape Apprentice) medically separated for asthma, rated at 10%.  

CI CONTENTION:  The CI requested the Board consider all conditions.  His complete submission is Exhibit A.  

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 20050830	VA* - (~1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20051123	
IBS (EPTS, not Service Aggravated)	Category II
	Irritable Bowel System	Not Service Connected	20051123	
Chronic Back Pain	Category II
	Lumbosacral Strain	Not Service Connected	20051123	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20060213 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Asthma Condition.  The service treatment record (STR) revealed the CI had no pre-existing pulmonary history.  He reported episodes of exercise induced wheezing and chest tightness in early 2005.  Prior to spirometry testing, Pulmonology prescribed Advair (inhalational steroid/long-acting bronchodilator combination) on a trial basis.  Stress test spirometry was performed on 17 March 2005 (2 weeks after being prescribed Advair) which revealed normal FEV1 with at least 12% improvement after bronchodilator treatment.  The provider diagnosed exercise induced asthma and recommended continued use of Advair medication to be taken twice a day and Albuterol (bronchodilator) as needed.  Military pharmacy medication profiles contained in the STR through the period of February 2004 to January 2005 indicated a nasal steroid spray (Flonase) being dispensed on 07 April 2004 with no refills.  Due to a non-deployable status, the CI was referred for a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) of 17 February 2005 (8 months pre-separation), the CI reported “asthma symptoms have been well controlled with Advair and albuterol.”  His physical examination (PE) was normal.  The commander’s statement was not specific for the sole diagnosis of asthma, but did note that the CI’s current physical condition severely limited his ability to serve.  At the VA Compensation and Pension (C&P) examination (23 November 2005; a month post-separation), the CI endorsed nocturnal orthopnea (short of breath when lying down), nocturnal shortness of breath at rest as well as with any increase in activities.  The frequency of an asthma attack was stated as “monthly”.  His active medications were noted to include two bronchodilators and one inhaled steroid (Albuterol, Serevent, and Advair).  His respiratory focused PE revealed wheezing in the upper lung fields.  The PFT evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Pulmonary Exam	
NARSUM ~8 Mo. Pre-Sep
	
VA C&P ~1 Mo. Post-Sep
	
FEV1 (% Predicted)	109	90	
FEV1/FVC	89	97	
Meds	Advair 	(+) inhalational steroid use	
§4.97 Rating	30%	30%	

The Board directs attention to its rating recommendations based on the above evidence.  The PEB rated the asthma condition at 10% citing no specific criteria whereas the VA rated 30% citing daily use of anti-inflammatory medication.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  The VA C&P examination being closer to separation was apportioned near exclusive probative value in determining an impairment rating.  Based solely on PFT parameters the CI’s condition did not meet compensable disability criteria.  A compensable rating for asthma in this case must be predicated therefore on the non-PFT criteria under VASRD code 6602.  The treatment criteria underpinning the 10% and 30% ratings are the pivotal points for decision in this case.  The Board must make a critical judgment as to the requirement for daily use of medication near the time of Service separation.  The 10% rating requires “intermittent inhalational or oral bronchodilator therapy”; the 30% rating requires “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  The VA examination clearly indicated the CI’s ongoing use of an inhalational anti-inflammatory (Advair) near the time of Service separation, thus supporting the 30% 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. 

Other PEB Conditions.  The other conditions forwarded by the MEB and adjudicated as category II (not unfitting) by the PEB was irritable bowel syndrome (IBS) and chronic back pain.  The NARSUM history noted the onset of adverse abdominal symptoms prior to service enlistment.  The CI underwent an exhaustive gastro-intestinal (GI) work-up with essentially benign results other than a few abnormal laboratory parameters that pointed towards a systemic allergic etiology to his spectrum of symptoms.  His last Gastroenterology report contained in the STR was 5 months prior to separation and clearly indicated that the CI was free of any abdominal pain or adverse abdominal symptoms.  Six months later at the C&P examination, the CI endorsed daily alterations of nausea, vomiting, diarrhea, and or constipation.  His PE documented upper abdominal tenderness.  Although his diagnosis remained unchanged, the provider indicated that the CI’s GI condition did not cause significant anemia or malnutrition.  
Additionally, the CI was evaluated by Rheumatology for nocturnal low back pain (LBP) and morning low back stiffness.  Diagnosed with ‘spondyloarthropathy’ (refers to any joint disease [not any specific condition] of the spinal column), the back pain condition was highly suspected, but not confirmed to be associated with his GI/colon condition.  The NARSUM examination (February 2005) was completely normal with regards to the back condition and its history indicated that the CI had back symptoms “for the last year”; therefore, dating back to February 2004.  During a majority of his time with back pain, his military performance was not hindered as evidenced in a highly rated enlisted performance report that covered the period of March 2003 to October 2004.  

Neither of these two conditions was specifically implicated in the commander’s statement and the CI’s profiles remained to state, “member is qualified to perform of primary duty requirements”.  All members agreed that there was no indication from the record that the IBS condition was not permanently service aggravated and that neither condition significantly interfered with the CI’s satisfactory duty performance.  All evidence considered there is not reasonable doubt in the CI’s favor supporting recharacterization of the PEB fitness adjudication for the IBS or chronic back pain condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  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 IBS and chronic back pain 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.  

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%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140610, 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-2014-02837.

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