RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03334
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141209
SEPARATION DATE:  20050302

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (6F051/Financial Management and Comptroller Journeyman) medically separated for asthma.  The asthma condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  Asthma was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “asthma” condition as unfitting, rated at 10%, referencing application of Department of Defense guidelines and the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB adjudicated obesity and tobacco abuse as Category III conditions.  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 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.  The obesity and tobacco abuse conditions were specified sufficiently in the application to meet the DoDI 6040.44 scope requirements; and are accordingly addressed below.  No additional 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 20050107	VA - (1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050419	
Obesity	CAT III	No VA Entry	
Tobacco Abuse	CAT III	No VA Entry	
Other x 0 (Not In Scope)	Other x 1	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20051031 (most proximate to date of separation)

ANALYSIS SUMMARY:

Asthma Condition.  Reviews of the service treatment record (STR) revealed the CI presented in June 2004 with 6-8 months history of episodic difficulty breathing, shortness of breath (SOB) and coughing.  The CI reported that the episodes awakened him at night, were produced by exercise; they took an hour to resolve and occasionally he coughed up blood.  A methacholine challenge study in July 2004 showed findings consistent with the diagnosis of asthma.  Albuterol (an inhaled bronchodilator) produced a dramatic improvement in symptoms.

At the narrative summary (NARSUM) on 19 October 2004 (5 months prior to separation), the CI reported SOB during physical activity, decreased exercise endurance from 25 minutes to the current 10 minutes, and awakening 1-2 times during the night with cough.  Physical examination noted he was overweight, had normal respirations and had clear lungs without wheezing.  “Current Medications” identified only an albuterol inhaler (to be used on an as needed basis) and a thyroid medication.  However, the examiner opined that his symptoms were well controlled with periodic use of a steroid inhaler (inhalational anti-inflammatory).

On a Health History form dated 27 December 2004 (2 months prior to separation); the CI indicated that he was using albuterol for asthma; no other medications were listed.  On the Report of Medical Assessment dated 25 January 2005 (a month prior to separation) the CI listed Albuterol as the only medication he was using for asthma.

During the VA Compensation and Pension (C&P) exam on 19 April 2005, 6 weeks after separation, the CI reported that while in the service he was treated with inhaled albuterol for asthma and oral antihistamine medications for allergies.  There was no mention of any other medication use while in the service.  He had not used his prescription medication since separation because he ran out of them.  Asthma symptoms occurred with strenuous activity and during the night while he slept.  He had not lost any work days because of illness in the previous 12 months.  Physical examination was normal.

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

Pulmonary Exam	MEB ~ 8 Mos. Pre-Sep	MEB ~ 8 Mos. Pre-Sep	VA ~ 2 Mos. Post-Sep	
FEV1 (% Predicted)	90	79	85	
FEV1/FVC	74%	83%	83%	
Meds	Albuterol	Albuterol	None	
§4.97 Rating	10%*	10%*	0% or 10%**	
	*Based on PFT result or intermittent inhalational bronchodilator
	**Conceding intermittent inhalational bronchodilator

Board members agreed that a 10% rating was justified by PFT results (i.e. FEV-1 of 71-80% predicted, or FEV-1/FVC of 71-80%) and by the documented use of intermittent inhaled bronchodilator therapy.  The next higher 30% rating requires daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication.  While the stipulation for the daily use of a bronchodilator was not met, the Board considered inhalational anti-inflammatory medication, which is not required to be used daily to satisfy the 30% rating.  Although the NARSUM examiner made the statement that periodic inhaled steroids were used, there are no other STR entries indicating the medication was ever prescribed; and the CI was clearly not using inhaled steroids at the time of the NARSUM and reported to the VA C&P examiner that Albuterol was the only asthma medication he had ever used.  The Board therefore concluded that the next higher 30% criteria were not met.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that obesity and tobacco abuse were not unfitting.  Obesity and tobacco abuse are conditions that do not constitute a physical disability.  The Board therefore has no reasonable basis for recommending these conditions as additionally unfitting for separation rating.

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 and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended obesity and tobacco abuse 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, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-03334.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings