RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03117
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050622

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

CI CONTENTION:  The CI contends that all conditions had worsened.  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 confined to 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 - 20050331	VARD - 20051222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20051004	
Chronic Laryngitis	Cat II	Chronic Laryngitis	6516	10%	20051004	
Narcolepsy		Narcolepsy 	8108	0%	10051004	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in 2003 after experiencing shortness of breath on exertion.  A diagnosis of asthma was made based on pulmonary function testing and clinical presentation.  The CI was treated several times for asthma and continued on his prescriptions of an inhaled bronchodilator (albuterol) and inhaled ant-inflammatory medication (Advair).  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “asthma, chronic laryngitis and narcolepsy” for PEB adjudication.  

The MEB NARSUM examination on 15 September 2004, 9 months prior to separation, noted that the CI’s symptoms improved, but he still had to use a bronchodilator 4-6 times per week before exercise and occasionally, during the night, after awaking with coughing.  Medications included Advair (inhalational anti-inflammatory medication) twice daily and Albuterol (inhalational bronchodilator) as needed.  Pulmonary function testing on 26 January 2005, 5 months prior to separation, showed an FEV-1 of 89% of predicted and an FEV-1/FVC of 84%.  The CI had a positive methacholine challenge test consistent with restrictive airway disease.  Treatment note in May 2005, 1 month prior to separation, listed medications as Advair and Albuterol.  The CI had two courses of systemic (oral) corticosteroids in 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.  At the 4 October 2005 VA Compensation and Pension (C&P) evaluation 4 months after separation, the examiner noted that the CI had been taking Advair twice daily and albuterol on an as needed basis.  Due to lack of insurance, the CI was not currently on inhalational steroids but was taking albuterol morning and night.  

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 rated the asthma condition 30% coded 6602, citing the CI’s daily use of oral bronchodilator therapy.  A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  All treatment notes and ratable examinations indicated that the CI was taking inhalational anti-inflammatory medication or daily inhalational bronchodilators, supporting the 30% 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, coded 6602.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the chronic laryngitis and narcolepsy conditions were not unfitting.  The aforementioned conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that his chronic laryngitis and narcolepsy conditions significantly interfered with satisfactory duty performance, aside from time lost due to prior surgeries.  After due deliberation, and 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 for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  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 chronic laryngitis and narcolepsy 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

PDBR PD-2014-03117

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to XXXXXXXXXXXXXXXXXXXXX, be corrected to show that:

		a.  The diagnosis in his finding of unfitness for Asthma, VASRD code 6602, was rated at 30% rather than 10%. 

		b.  On 21 June 2005, he elected not to participate in the Survivor Benefit Plan.

		c.  He was not discharged on 22 June 2005 with entitlement to disability severance pay; rather, on that date he was released from active duty and on 23 June 2005 his name was placed on the Permanent Disability Retired List.