RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00838
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E5, Utilities Journeyman, medically separated for “asthma” with a disability rating of 10%.

CI CONTENTION:  The CI requested 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 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 - 20050825	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050518	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  The CI developed respiratory symptoms in August 2004 while deployed and was treated for possible pneumonia.  His respiratory symptoms persisted and he was diagnosed with asthma by a pulmonologist in October 2004. At the October 2004 pulmonary clinic examination, the CI was prescribed inhalational anti-inflammatory medication and inhalational bronchodilators.  A primary care appointment in December 2004 showed the CI was prescribed an oral bronchodilator (Singular).  The CI experienced a flare of asthma, experiencing an increase in chest tightness and a lack of response from the albuterol asthma, requiring emergency room (ER) visit in January 2005.  At a follow-up primary care visit the following day, the provider started the CI on a new inhalational anti-inflammatory medication and a corticosteroid taper (Prednisone).  In February 2005, the CI returned to the ER and was again placed on a corticosteroid taper (Prednisone).  Pulmonary function tests (PFT) were performed in October 2004, May 2005 and September 2005, with the results annotated in the chart below.  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 MEB.  At the 18 May 2005 VA Compensation and Pension (C&P) examination (5 months prior to separation), the examiner noted that the CI was using inhalational anti-inflammatory (Fluticasone and Advair) twice daily, oral bronchodilator (Singular) once a day, and inhaled bronchodilator as needed.  PFTs are noted in the chart below.  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 ~12 Mos. Pre-Sep	Pulm ~6 Mos. Pre-Sep	VA ~2 Mos. Pre-Sep	
FEV1 (% Predicted)	100%	82%	82%	
FEV1/FVC	85%	83%	81%	
Meds	None – initial Pulmonary evaluation	Daily bronchodilator / inhaled anti-inflammatory 	Daily bronchodilator / inhaled anti-inflammatory	
§4.97 Rating	0% 	30%	30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA rated the asthma condition 10%, coded 6602 (asthma).  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 examinations in evidence reported current prescription and use of daily bronchodilators. Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed, as noted by the pulmonary clinic and VA C&P examiners.  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.  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.  

BOARD FINDINGS:  In the matter of the Asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

PDBR PD-2015-00838

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 30 October 2005, he elected not to participate in the Survivor Benefit Plan and on that same date, his spouse, XXXXXXXXXXXXXXXXXXXXX, concurred with his election.

		c.  He was not discharged on 31 October 2005 with entitlement to disability severance pay; rather, on that date he was released from active duty and on 1 November 2005 his name was placed on the Permanent Disability Retired List.

XXXXXXXXXXXXXXXXXXXXX