RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00321
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040602

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E4, Electrical Power Production Journeyman, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  The CI was given a higher rating by the VA.  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 - 20040408	VARD - 20040909	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20040603	
Tobacco Abuse.	Not Unfitting Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

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 September 2003 after an acute episode of shortness of breath and cough with wheezing while stationed in Iraq.  The CI was medically evacuated to Germany and then returned to the United States for further evaluation and treatment.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation in October 2003.  An inhaled steroid/bronchodilator combination (Advair) and an oral bronchodilator (Singulair) in addition to a corticosteroid (Prednisone) medications were prescribed.  

Treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “asthma and reactive airway disease” for PEB adjudication.”  On 07 October 2003, 8 months prior to separation, PFTs showed an FEV-1 of 73% of predicted and an FEV-1/FVC of 68%.  Repeat PFTs on 13 November 2003, 7 months prior to separation, showed an FEV-1 of 72% of predicted and an FEV-1/FVC of 69%.  

The MEB NARSUM examination on 07 December 2003, 6 months prior to separation, noted that the CI was taking Advair twice daily, Albuterol (inhaled bronchodilator) for exacerbations, Singulair and Zyrtec (antihistamine).  The examiner noted the CI’s lungs were remarkable for “expiratory wheeze” bilaterally.  Review of the STR showed clinical encounters and medication profiles in evidence documenting the use of an oral or parenteral steroid for asthma during the year prior to separation.  According to the pulmonary clinic evaluation on 1 June 2004, the CI indicated he wheezes daily and awakens nightly due to breathing distress.  PFTs 1 day prior to separation, showed an FEV-1 of 75% of predicted and an FEV-1/FVC of 73%.  

At the 03 June 2004 VA Compensation and Pension (C&P) evaluation, performed 1 day after separation, the examiner noted the CI was taking multiple different asthma medications, which included:  Advair, Atrovent (inhalational bronchodilator), Flovent (inhalational steroid), Zyrtec, and Singulair.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing PFTs showed that his post bronchodilator FEV-1 was 72%.  The VA rated the asthma condition 30% coded 6602, citing an “FEV-l of 56 to 70 percent of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV 1/FVC) of 56 to 70 percent; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication.”  A 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members considered that the NARSUM and pulmonary clinic exams reported current prescription and use of daily bronchodilators and inhaled anti-inflammatories.  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.  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.  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 20150519, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAF/MR
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00321.

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 XXXXXXXXXXXXXXXXXXXXX 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,

XXXXXXXXXXXXXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings 

cc:
SAF/MRBR