RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00396
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070619

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

CI CONTENTION:  “Review 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 - 20070502	VARD – No VA Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	NA				
Obesity	Category III	NA				
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sought treatment in November 2006 with complaints of shortness of breath and wheezing.  At the 29 November 2006 acute encounter the CI complained of intermittent difficulty breathing, wheezing, and lung pain for approximately a year.  He was having no difficulty breathing at the time of examination.  Pulse oximetry (measures peripheral arterial oxygen saturation as a percentage of oxygenated hemoglobin with normal being 95-100%) was 99% and the body mass index ([BMI] measure of body fat based on height and weight) was 33.14 (obesity class I = 30.0 to 34.9 kg/m2).  The baseline pretreatment peak flow (peak expiratory flow rate [PEFR] maximal exhalation rate [L/min] during a short maximal expiratory effort after a full inspiration) was 400 (predicted 625).  The CI was given an Albuterol (inhalational bronchodilator) nebulizer and there was no change to the post-treatment peak flow of 400.  The chest examination was normal and the lung examination revealed a slight decrease in breath sounds in the bilateral bases with no wheezing.  The assessment listed mild unspecified asthma.  The examiner prescribed one albuterol inhaler (25-day supply) with directions to inhale two puffs every 4-6 hours as need for wheezing and placed a consult for pulmonary function tests (PFTs).  At the 14 December 2006 pulmonology/sleep medicine consultation, the CI complained of gradual progression of shortness of breath, cough, and wheezing with exercise for the last year.  Since moving from New Mexico about 5 years prior, he noticed burning substernal discomfort with exercise and associated cough and wheezing.  The CI noted improvement since using an Albuterol inhaler twice a day as needed.  He reported that environmental allergens worsened his symptoms in the spring.  The CI denied reflux symptoms and, “He states that he has been told that he snored and he would wake himself up choking until he lost about 30 pounds of weight and this has improved.”  The CI underwent PFTs comprised of pre- and post-bronchodilator spirometry (measuring lung function in terms of volume and/or flow of air inhaled and exhaled).  “This spirometry consisted of pre- and post-bronchodilator spirometry.  The flow volume loop, pre-bronchodilator shows slowing of air flow at lower lung volumes.  This returned to normal following bronchodilators.  The numbers themselves show an FVC that is 5.38 liters, FEV1 of 4.25 liters and an FEV1/FVC ratio of 79%, all of which are normal.  However, the FEF 25-75% was 3.81 liters per second or 76% predicted.  This parameter did improve 14% with bronchodilator use.  The examiner stated, “This spirometry is consistent with small airway obstructive disease, which improves with bronchodilators and hence, would be consistent with a clinical diagnosis of bronchial asthma.”  The assessment listed symptoms suggestive of persistent mild bronchial asthma with an associated cough.  The pulmonologist gave him samples of Advair 250/50 (combination inhalational bronchodilator and anti-inflammatory) for one puff twice daily and Spiriva (long-acting inhalational bronchodilator) once a day.  At the 24 January 2007 pulmonology follow-up, the CI reported his baseline peak flows varied from 450 to 500 before he started using Advair (one puff twice daily).  Once he started Advair, they gradually increased up to a consistent level about 550, and his cough improved.  The CI reported two exacerbations after exposure to cold air and secondhand cigarette smoke.  Symptoms improved with Albuterol inhaler use.  The impression listed mild to moderate persistent bronchial asthma, improved with Advair, and a significant component of airway hyper-reactivity.  The plan was to continue the Advair, start Combivent (combination inhalational bronchodilator), and continue checking peak flows.  The CI filled the prescription on 25 January 2007 for one Combivent inhaler (25 day supply) with directions to inhale two puffs every 4 hours as need for dyspnea (shortness of breath).  The CI filled a prescription on 30 January 2007 for an Advair inhaler (30-day supply) with directions to inhale one puff twice daily.  The 8 March 2007 NARSUM, 3 months before separation, recounted the history and interventions.  The CI reported occasional shortness of breath since being started on Combivent, but none in the last week.  He indicated his coughing had decreased and denied wheezing.  The CI had otherwise done well with his asthma and had had no exacerbations.  Reported medications were Advair (one puff twice daily) and Combivent (one puff four times daily as needed).  The physical examination recorded the BMI was 33 (obesity class I) and recent peak flows (X3) were 550 consistently.  The chest examination revealed the lungs were clear to auscultation with good breath sounds bilaterally.  There were no rales (abnormal respiratory sounds from fluid accumulation), rhonchi (abnormal respiratory sounds from airway secretions), or wheezes.  The examiner cited the PFTs and pulmonary consultations.  The assessment listed “clinical diagnosis of asthma by the pulmonology.”  The 27 March 2007 pulmonology follow-up documented, “He noted that the Spiriva once a day appeared to work better than Advair, although he is still using Advair but not as regularly.  He also uses an albuterol inhaler as needed.  He went back home to New Mexico and noted that his symptoms completely resolved, and that once he came back to Montana he started again having problems with shortness of breath and cough occasionally.”  The physical examination revealed his chest was clear with good ventilation.  The impression listed mild bronchial asthma associated with sensitivity to airway irritants and some allergens.  The plan documented, “Suggest that he continue with Spiriva once a day.  I will switch from Advair to Pulmicort to use two whiffs once a day and use albuterol p.r.n.  [as needed]  I will see him back as needed.”  The CI filled a prescription on 3 April 2007 for one Pulmicort (inhalational anti-inflammatory) inhaler (30-day supply) with directions to use once daily, and one Albuterol inhaler (25-day supply) with directions to inhale two puffs every 4 hours as need for dyspnea.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 6602 (asthma, bronchial).  There was no VA disability claim in evidence.  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.”  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed.  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/or 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. 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.  

Contended PEB Condition: Obesity.  The Board’s main charge is to assess the fairness of the PEB’s determination that obesity was a category III (not separately unfit and compensable/ratable)   condition.  Obesity is a condition not constituting a physical disability IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended. 

BOARD FINDINGS:  In the matter of the asthma condition, the Board majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  In the matter of the contended obesity condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150530, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00396.

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 XXXXXXXXXXXXXXXXXXX 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,

XXXXXXXXXXXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings 

cc:
SAF/MRBR 
DFAS-IN