RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03022
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150515
SEPARATION DATE:  20060703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Satellite Wideband and Telemetry Systems) medically separated for asthma.  The asthma condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “moderate 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 adjudicated “asthma” as an unfitting condition, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Tobacco habituation and obesity were determined to be Category III conditions (not separately unfitting and not compensable or ratable).  The CI made no appeals 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 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/Naval 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 20060518	VA* - (~3 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20060929	
Tobacco Habituation	Cat III	No VA Placement	
Obesity	Cat III	No VA Placement	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20061027 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Asthma.  The CI was first seen for shortness of breath in early 2006.  It was associated with a cold, smoking, and recent contact with a dog (to which he was allergic).  He was treated with an inhaler and began a smoking cessation program.  He continued to have symptoms and was seen in the emergency room for asthma 2 weeks later.  He was seen several more times for asthma before being entered into the MEB process.  He was able to stop smoking, but began again, citing stress from the MEB and occupation (his commander noted that he was a less than average performer).  The narrative summary was dated 12 April 2006.  The CI reported that his symptoms had begun while deployed the previous year and continued after his return in September.  He was smoking on pack per day and also used the inhaler daily.  His baseline pulmonary function tests (PFTs) were normal other than the FEV1/FVC ratio which was reduced at 66%.  A provocative test for asthma, a Methacholine challenge test, was positive.  He was also noted to be obese.  His lungs were clear on examination.  He was advised to stop smoking, but declined.  He was also begun a daily inhaled anti-inflammatory agent.  

At the VA Compensation and Pension (C&P) examination performed 3 months after separation, the CI reported improvement with medications, but continued symptoms with running or around dogs.  He was able to run 1-2 miles before he became short of breath.  He reported a morning cough, but was noted to continue to smoke.  His lungs were clear and PFTs (below) normal.  

Pulmonary Exam	MEB ~3 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
FEV1 (% Predicted)	100	90	
FEV1/FVC %	66	74	
Meds	Albuterol	Albuterol/Advair	
§4.97 Rating	30%	30%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both used the code 6602 (asthma), but rated the condition at 10% and 30% respectively.  The use of daily medications and the use of an anti-inflammatory agent both support a 30% rating.  The Board observed that the asthma condition was almost certainly aggravated by the ongoing tobacco abuse, but that there is no mechanism in the VASRD to deduct for this.  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.  

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 §4.100.  Tobacco abuse and obesity are not physical disabilities IAW DoDI 1332.38 E5.1.3.9.1 and E5.1.3.10.  The Board unanimously recommends no change in the PEB adjudication.  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 20140619, 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-2014-03022.

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