RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00058
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Airfield Management Operations Supervisor, medically separated “asthma” with a disability rating of 10%.

CI CONTENTION:  VA rated the CI 80% with the same documentation available to the MEB.  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 - 20040827	VARD - 20041214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20041020	
OSA with Restless Leg Syndrome	Cat II	OSA with Restless Leg Syndrome	6847	50%	20041002	
Allergic Rhinitis	Cat II	Allergic Rhinitis	6522	0%	20041002	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

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 January 2003, and manifested as cough, dyspnea (difficulty breathing) on exertion and wheezing.  Despite treatment, the asthma condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “asthma” for PEB adjudication.

As confirmed by contemporaneous STRs (to include the MEB NARSUM) during the time leading up to separation and corroborated by the VA C&P examination 1 month before separation, the CI had active prescriptions for an inhaled bronchodilator (Albuterol) taken as needed, and an anti-inflammatory medication (Advair) taken 2 times daily.  The STR contained two prescriptions for a systemic (oral) corticosteroid given for an acute asthma exacerbation during the year prior to separation.  The pulmonary function evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  The pulmonary function tests found in STR and VA evidence, proximate to separation, ranged from FEV-1 predicted 82% to 92%; while the FEV-1/FVC ration ranged from 75 to 83%.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA rated the asthma condition 30%, also coded 6602 based on the VA C&P examination 1 month before separation, citing inhalational anti-inflammatory medication (Advair).  A 30% rating stipulates “FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  While PFT’s in evidence did not warrant a rating higher than the PEB’s 10%, Board members considered that an inhaled anti-inflammatory (Advair) was prescribed and used (as noted by multiple examinations in evidence, the NARSUM examiner and VA C&P examination).  It was therefore agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication use.  Because there was no evidence of at least 3 courses of systemic corticosteroids during the year prior to separation, the next higher 60% rating was not warranted.  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:  Obstructive Sleep Apnea (OSA) with Restless Leg Syndrome, and Allergic Rhinitis Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.

OSA associated with Restless Leg Syndrome.  According to the STR and the MEB NARSUM, the CI had a history of excessive daytime sleepiness since 1994, restless leg syndrome since 1999 treated with medication, and witnessed episodes of apnea since approximately 2002.  An Enlisted Performance Report covering the period from 12 March 2003 through 11 March 2004 stated “superior performer; energy and good judgment…” and “Excellent work ethic and motivation.”  A sleep study in April 2004 (after initiation of the MEB process) indicated the presence of OSA requiring continuous positive airway pressure (CPAP), and mild periodic limb movements.  A follow-up sleep study on 29 June 2004, performed to determine appropriate CPAP treatment settings, noted no significant periodic limb movements.  CPAP for treatment of OSA was instituted in July 2004.  The final profile in evidence (a temporary P4 profile on 21 May 2004, prior to CPAP treatment) included asthma and OSA, but not restless leg syndrome.  An STR entry on 17 August 2004 indicated an updated profile was accomplished, but this profile is not in evidence.  The commander’s statement on 26 July 2004 did not specify OSA or restless leg syndrome as impediments to duty, but did indicate that “conditions cause him to feel confused and unable to mentally focus.”  The MEB submission listed asthma and OSA, but not restless leg syndrome.  At the VA C&P examination on 20 October 2004 (1 month prior to separation), the CI reported that he experienced difficulty sleeping at night and was tired during the day, but that this did not interfere with daytime activities.  CPAP and medication were reportedly helpful for the OSA and restless leg syndrome, and the examiner stated that OSA caused no functional impairment.

Regarding restless leg syndrome, the Board considered that it was not profiled and was not adjudged to fail retention standards.  Moreover, although a previous sleep study noted the presence of “mild” periodic limb movements, the final sleep study in June 2004 noted no significant limb movements.  Board members concluded therefore that this condition should not be deemed unfitting.

Regarding the OSA condition, the Board considered that it was identified on the last available profile and by the NARSUM, both of which were dated prior to the institution of CPAP treatment.  Although the commander’s statement reported the CI to “feel confused and unable to mentally focus,” this was not attributed specifically to OSA and was also not consistent with a performance report that noted “superior performance” and “energy.”  As noted by the pre-separation C&P examination however, CPAP treatment was noted to be helpful; and indeed the condition resulted in no functional impairment.  The Board therefore concluded that the OSA condition could not be considered unfitting.  Furthermore, the evidence indicates that the OSA condition did not come to attention until the time of the MEB process, rendering the fitness determination subject to DoDI 1332.38 (E3.P3.3.3 - Adequate Performance Until Referral); which stipulates, “If the evidence establishes that the Service member adequately performed his or her duties until the time the Service member was referred for physical evaluation, the member may be considered fit for duty even though medical evidence indicates questionable physical ability to continue to perform duty.”  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the obstructive sleep apnea associated with restless leg syndrome condition, and so no additional disability rating is recommended.

Allergic Rhinitis.  According to the STR and the MEB NARSUM, the CI had a history of severe eye and nasal symptoms.  He tested positive for mold, was diagnosed with allergic rhinitis by an allergist, and was treated with “as needed” nasal steroid sprays and oral antihistamines.  The condition was not profiled or implicated by the commander’s statement, and was not judged to fail retention standards.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the allergic rhinitis condition and so no additional disability rating is 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 obstructive sleep apnea associated with restless leg syndrome, and allergic rhinitis 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 20141015, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXXX

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on XXXXXXXXXXXXXXXXXXXXX
	  Case Number PD-2015-00058

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended the separation be re-characterized to reflect permanent disability retirement with a combined disability rating of 30% rather than 10%.

I have reviewed the application and Record of Proceedings and I recommend you accept this proposed decision.

As a reminder, a copy of your decisional documents must be provided to the PDBR at the following address:

XXXXXXXXXXXXXXXXXXXXX

	Sincerely,

Attachments
1.  Record of Proceedings
2.  Case File