RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03848
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Medical Laboratory Journeyman, medically separated for “moderate persistent asthma,” with a disability rating of 10%.

CI CONTENTION:  The CI submitted a long narrative as to why his condition warranted a higher rating by the PEB.  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 upon a 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 - 20070529	VARD - 20080403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Persistent Asthma	6602	10%	Asthma	6602	30%	20080228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Moderate Persistent Asthma.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a preceding history of rhinitis and allergies with the development of bronchospasm (wheezing) about 6 months before separation.  This evolved into persistent asthma, diagnosed by a methacholine challenge test.  The CI was started on a rescue inhaled bronchodilator (albuterol), a daily inhalational anti-inflammatory (Flovent), and a daily oral bronchodilator (Singulair).  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 “moderate persistent asthma” for PEB adjudication.

The NARSUM examination on 13 April 2007 (4 months before separation) stated, “Currently symptomatic with triggers of pollens, emotion, exertion,” somewhat relieved with albuterol inhaler, and “feeling better after these last 2 months on Flovent.  Currently using albuterol 3-4 times a week for rescue.”  There were no pharmacy dispensing records in evidence, but there were multiple STR entries with automated medication lists that indicated continuing use and compliance.  There was an intravenous bolus of corticosteroid in the emergency room followed promptly by a short course of oral corticosteroids (prednisone 60 milligrams daily for 5 days) about four months before separation.  There were two pulmonary function tests (PFT) in the STR with measurements (post-bronchodilator) of FEV1 of 91% and 104% predicted, and FEV1/FVC ratios were 109% for both (all normal).  There was no STR evidence for additional use of systemic corticosteroids; and, no evidence of respiratory failure, hospital admissions, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  The above medications and daily Singulair were listed in the NARSUM medication list and on the MEB’s DD Form 2697, Report of Medical Assessment.  

At the 28 February 2008 VA Compensation and Pension (C&P) examination, performed 7 months after separation, documented persistent symptoms and a “current treatment” list that included daily Advair (same class as Flovent), daily Singulair, and daily albuterol.  No use of systemic corticosteroids was mentioned, and the C&P cited the Service PFT results.

The Board directed attention to its rating recommendation based on the above evidence.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602 (asthma).  The PEB did not elaborate the criteria for its 10% determination.  The VA’s rating decision stated that its 30% determination was “based on the need for daily inhalational therapy.”  Members first agreed that the systemic corticosteroid criterion for a 60% rating was not satisfied by the evidence (a single course with no indication that it was ever required again).  The PFT criteria even for a 10% rating were not supported; but, members agreed that the 30% treatment criteria of both daily inhalational or oral bronchodilator and inhalational anti-inflammatory were well supported by the Service and VA evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 30% rating for the asthma condition under code 6602.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a Service 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 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	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140826, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

PDBR PD-2014-03848

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 e 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 2 August 2007, he elected child-only coverage under the Survivor Benefit Plan based on full retired pay and on that same date, his spouse, concurred with his election.

		c.  He was not discharged on 3 August 2007 with entitlement to disability severance pay; rather, on that date he was released from active duty and on 4 August 2007 his name was placed on the Permanent Disability Retired List.