RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00491
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050927

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:  The CI did not submit a contention in the application.  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 - 20050809	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	60%	20051201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first treated for symptoms of restrictive lung disease on 15 June 2005, although he   had shortness of breath (SOB) and dyspnea on exertion starting in February 2005 and a history of a right infrahilar (below the site of the bronchus and vessels that enter the lung) infiltrate consistent with atelectasis or pneumonia in October 2003.  He was prescribed Advair (fluticasone/salmeterol, an inhalation steroid/bronchodilator combination).  The CI was evaluated at the pulmonary clinic on 27 June 2005 for his recent history of increasing SOB, cough, wheezing, chest tightness and occasional pleuritic chest pain.  A chest X-ray dated 15 June 2005 did not demonstrate any effusions, masses or interstitial abnormalities and the heart size and pulmonary vasculature were normal.  Pulmonary function testing (PFT) showed a moderately severe restriction pattern.  At the primary care clinic appointment on 5 July 2005, 3 months prior to separation, the CI reported that he had “stopped using Advair 2 weeks ago because of side effect causing severe sore throat.”  A methacholine challenge test performed on 5 July 2005 showed a decrement of greater than 20% in two out of three studies with symptoms of cough and SOB and the diagnosis of “moderate persistent asthma” was made based on test results and clinical presentation.  Albuterol, an inhaled bronchodilator, was prescribed on an “as needed” basis and the Advair was continued.  The CI was recommended for a P4 profile and determined unqualified for world-wide duty.  Based on this, the MEB forwarded “moderate persistent asthma” for PEB adjudication.  However,   The MEB NARSUM dated 5 July 2005 indicated the CI was to start Advair and had Advair teaching.  During a telephone consultation on 4 August 2005, the provider recorded that the CI was “doing well currently on Advair and albuterol.”  The CI reported that he had “to use albuterol…at most 1 time per week.”   

At the 1 December 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported shortness of breath depending on air quality and it occasionally occurred when walking/exercising.  He also reported asthmatic attacks weekly and that he needed to visit a physician to control the attacks as often as two times per year.  The examiner noted that the CI did “not require any treatment for his respiratory condition.”  On examination he was in no acute distress and his breath sounds were symmetric without rhonchi or rales (sounds of fluid or obstruction in the lung) and the expiratory phase was within normal limits.  The pulmonary function test examiner recorded that the CI provided a good effort and that there was “no discrepancy between the PFT findings and the clinical examination.”  

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.  

Pulmonary Examination	Pulm ~3 Mos. Pre-Sep	MEB ~3 Mos. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
FEV1 (% Predicted)	71	72	53	
FEV1/FVC	79	79	84	
Meds	Not specified	Intermittent bronchodilator and inhaled anti-inflammatory 	Requires no treatment	
§4.97 Rating	PEB 10%	30%	VA 60%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6602 code (asthma), citing asthma.  The VA assigned a 60% rating under the 6602 code (asthma), citing FEV-1 of 53% of predicted. 

A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Board members agreed that the PEB’s 10% rating was justified by FEV-1 of 71 and 72-percent predicted and/or the FEV-1/FVC of 79 percent noted by the pulmonary and MEB examinations.  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 some of the examinations in evidence reported current prescription and use of inhaled anti-inflammatories (Advair), which are not specified as a daily requirement under the 30% rating provision.  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.  Although the VA rated his asthma condition at 60% based on the CI’s FEV-1 of 53%, Board members assigned more probative value to the MEB PFTs because they were more consistent with the clinical presentation, and more importantly, the CI reported not to be taking medication, which may have accounted for the FEV-1 at the VA examination as compared to prior examinations.  The Board considered other routes, but 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.  

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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00491.

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 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,

Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings 

cc:
SAF/MRBR