RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03584
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20021030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Satellite Wide Band Communications, medically separated for “asthma, exercise-induced,” with a disability rating of 10%.  

CI CONTENTION:  The CI indicates a disparity between his Service disability rating (10%) and the rating from the VA (30%).  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 on 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 - 20020910	VARD - 20030805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Exercise-Induced	6602	10%	Bronchial Asthma	6602	30%	20030530	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma, Exercise-Induced.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI was evaluated in May 2002 for a history of shortness of breath.  On 3 June 2002, pulmonary function tests (PFTs) were done.  The forced expiratory volume in the first second (FEV-1) was 3.91 liters (85% of predicted).  The FEV-1 divided by forced vital capacity (FVC) was 84%.  These PFTs were interpreted as normal.  The CI then had a methacholine challenge test, which was interpreted as moderately positive.  This led to a diagnosis of asthma.  A daily inhaled anti-inflammatory medication (Advair) was prescribed, along with a bronchodilator (albuterol) to be used on an “as needed” basis.  Due to the chronic nature of his asthma condition, the CI underwent an MEB.  The MEB forwarded “asthma” for PEB adjudication.  According to the NARSUM examination on 13 June 2002 (5 months prior to separation) the CI was on a daily dose of inhaled anti-inflammatory medication (Advair).  The examiner stated that the CI would continue Advair on a daily basis as prescribed.  At the Family Practice visit on 26 August 2002 (2 months prior to separation) it was noted that the CI was taking an inhalational anti-inflammatory (Advair), and a bronchodilator (Albuterol).  Review of the STR showed 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.  

At the VA Compensation and Pension (C&P) evaluation on 30 May 2003 (7 months after separation), the examiner noted that the CI was taking intermittent inhalational anti-inflammatory medication, and daily bronchodilator (the particular medications were not specified).  Pulmonary function tests (PFTs) were done.  The FEV-1 was 2.87 liters (63% of predicted).  The FEV-1 divided by FVC was 83.7%.  These PFTs were interpreted as “moderate restriction” which improved with bronchodilation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10% (coded 6602), with no specific rationale cited for the rating.  The VA rated the asthma condition 30% (coded 6602), citing VASRD criteria for that rating level. 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.”  The Board determined that the exams in evidence reported prescription and use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were used (as noted by the examiners listed above).  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and inhalational anti-inflammatory medication use.  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.  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 exercise induced asthma, coded 6602.  

BOARD FINDINGS:  In the matter of the exercise induced asthma, 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 therefore 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, Exercise-Induced	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140731, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03584.

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