RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00696
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061107

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

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 - 20060928	VARD - 20071002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20070717	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 July 2003 with a cough.  He was diagnosed with post-infectious reactive airway disease and prescribed prednisone.  He did well until 22 January 2004 where X-rays showed pneumonia and he was placed on inhaled bronchodilators (albuterol).  Over the next few years, he was seen periodically for shortness of breath and treated with bronchodilators and anti-inflammatory agents.  On 2 March 2006 his Singulair was refilled.  On 14 March 2006 his Advair dose was increased.  The pulmonary function tests (PFTs) dated 4 August 2006 showed borderline bronchial hyper-responsiveness.  He then had provocative testing (methacholine challenge) which was positive for asthma.  Despite treatment, the asthma condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “asthma” for PEB adjudication.  According to the family practice clinic evaluation on 15 August 2006, 3 months prior to separation, the examiner noted the CI was on Advair and used albuterol once a day.  The MEB NARSUM examination on 16 August 2006, 3 months prior to separation, noted the CI was taking both an anti-inflammatory agent and a bronchodilator, as needed.  Review of the STR showed one 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 17 July 2007 VA Compensation and Pension (C&P) evaluation 8 months after separation), the examiner did not specify what medications were being used.  PFTs were normal.  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	VA C&P ~8 Mos. Post-Sep	
FEV1 (% Predicted)	91%*	93%	
FEV1/FVC	97%*	82%	
Meds	Advair; *post-treatment	not specified	
§4.97 Rating	30%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, with likely application of DoDI 1332.39 rating guidance in effect at the time, which differed from VASRD rating criteria.  The VA rated the asthma condition 0%, coded 6602, citing normal PFT results.  The criteria for a 30% rating include daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.  These were prescribed and used by the CI.  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 3 per year) courses of systemic corticosteroids.  The PFT evidence did not 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 §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends the CI’s prior determination be modified as follows; and, 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
PDBR PD-2015-00696

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to XXXXXXXXXXXXXXXXXXXXX, be corrected to show that:

		a.  The diagnosis in his finding of unfitness for Asthma, VASRD code 6602, was rated at 30% rather than 10%.

		b.  On 7 November 2006, he elected spouse-and-child Survivor Benefit Plan coverage based on full retired pay.

		c.  He was not discharged on 7 November 2006 with entitlement to disability severance pay; rather, on that date he was released from active duty and on 8 November 2006 his name was placed on the Permanent Disability Retired List.