RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00140
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060502

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

CI CONTENTION:  “Please consider all conditions.” 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 - 20060215	VARD - 20080201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Severe Persistent	6602	10%	Asthma	6602	10%	20071113	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma, Severe Persistent.  According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI’s asthma condition was diagnosed in August 2005, at which time he complained of a 2-year history of respiratory symptoms exacerbated by exercise.  Pulmonary evaluation in August 2005 confirmed severe reversible airway obstruction characteristic of asthma.  Despite treatment, the CI’s asthma condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and he was referred for an MEB.  

Pulmonary function testing (PFT) on 11 August 2005 (9 months prior to separation) showed an FEV-1 of 61% of predicted and an FEV-1/FVC of 59%.  Treatment with an inhaled bronchodilator, to be used as needed, was started in August 2005, and in October 2005, a prescription for a twice-daily inhaled anti-inflammatory agent (Advair) was written.  At the MEB NARSUM examination on 20 December 2005 (5 months prior to separation), the CI reported a history of shortness of breath with chest discomfort exacerbated by exercise, and worse shortness of breath at night.  The NARSUM examiner stated that the CI “has been on Albuterol and Advair inhalers since diagnosis….”  Current medications were listed as albuterol as needed and Advair twice per day.  The diagnosis was severe persistent asthma.  Review of the STR showed two separate clinical encounters in evidence documenting the use of an oral steroid for asthma during the year prior to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, code 6602 (asthma, bronchial).  The VA rated the asthma condition 10% using the same code, citing use of an as-needed inhaler and PFTs performed 18 months after separation, which were not relevant to the Board’s deliberations.  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 considered that the only PFTs proximal to the date of separation justified a 30% rating (for FEV-1 of 61% of predicted and FEV-1/FVC of 59%).  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed, as noted by two STR entries and the NARSUM examiner.  Board members 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.  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.  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 Condition: Tobacco Habituation.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Tobacco abuse is a condition that does not constitute a physical disability, IAW DoDI 1332.38.  The Board therefore has no reasonable basis for recommending this condition as additionally unfitting for separation rating.

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 tobacco habituation condition, the Board unanimously recommends no change from the PEB determination 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, Severe Persistent	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141110, 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 XXXXXXXXXXXXXXXXXXXX Case Number PD-2015-00140

	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