RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00130
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050610

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

CI CONTENTION:  Veterans Affairs rated his asthma condition as 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 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 - 20050119	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Bronchial Asthma	6602	30%	20051031	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in July 2004.  The CI was evaluated in August 2004 for symptoms of cough, shortness of breath, chest tightness, and wheezing.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  Inhaled bronchodilators (Albuterol) were prescribed on an “as needed” basis.  Inhaled steroids (Flovent) were started in July 2004, but were evidently discontinued because they only appear once in the record.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “intrinsic asthma” for PEB adjudication.

The MEB NARSUM examination on 8 October 2004, 8 months prior to separation, noted that the CI was taking Albuterol on an “as needed” basis.  Pulmonary function testing (PFT) on 23 August 2004 (10 months prior to separation) showed an FEV-1 of 97% of predicted and an FEV-1/FVC of 73%.  Review of the STR showed one separate clinical encounter 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.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.

At the VA Compensation and Pension (C&P) evaluation on 31 October 2005 (5 months after to separation) the examiner noted that the CI was taking Combivent (inhaled bronchodilator) three times a day.  A PFT showed an FEV-1 of 93% of predicted and an FEV-1/FVC of 66%.

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%, also coded 6602 based on the VA C&P examination 5 months after separation, citing the ratio of FEV-1 to forced vital capacity (FEV-1/FVC) of 56 to 70 percent or daily inhalational 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.”  Board members noted that the CI was prescribed Flovent (an inhaled corticosteroid).  Although reported discontinuance in October 2004, a general surgery note in April 2005 (2 months prior to separation) documented Flovent and Albuterol for asthma.  At the VA examination the CI reported Albuterol and a second inhaler were used in service and the VA examiner noted current prescription and use of daily bronchodilators.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator 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 asthma condition, coded 6602.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97. 

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%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150204, 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-2015-00130

	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