RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00867
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091126

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

CI CONTENTION:  “The rating I received reflected a decision that did not take into account future problems I would encounter with this condition.”  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 – 20090831	VARD – 20100707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in March 2009 after he developed a significant cough and shortness of breath (SOB).  The CI was treated with albuterol (a bronchodilator) at an emergency department (ED) on 24 March 2009 and diagnosed with bronchitis.  Returning to the ED, he was hospitalized from 24-26 March 2009 and discharged with the diagnoses of bronchitis and reactive airway disease.  Medications included prednisone (an oral steroid), Advair (an inhaled steroid bronchodilator), and albuterol.  On 30 March 2009 the CI was evaluated by a pulmonologist and noted to have had acute asthma, likely allergy-initiated.  On examination his chest was clear, X-ray revealed clear lungs and a normal-sized heart.  Peak flow testing was 530 liters/minute with a predicted normal of 602 liters/minute.  The pulmonologist suggested the CI decrease his dose of Advair, taper off steroids completely, and use an albuterol inhaler as needed.  On 1 April 2009, 8 months prior to separation, pulmonary function tests (PFTs) showed a post-drug FEV-1 (forced expiratory volume at 1 second) of 100% predicted and an FEV-1/FVC (forced vital capacity) of 105% predicted.  On 6 April 2009, the pulmonologist clarified his prior evaluation noting the CI had mild, intermittent asthma with his most recent and only attack being through exposure to dog dander.  The CI was tapered off steroids.  The pulmonologist felt if the CI continued to do well, Advair could be discontinued, he could be maintained on ‘as needed’ bronchodilators, and he opined the CI’s prognosis was excellent for the long haul.  

At the 30 April 2009 MEB NARSUM examination, 6 months before separation, the examiner noted the CI recovered within a week of symptom onset, had no functional limitations or need to use his albuterol inhaler and did not require duty or fitness restrictions.  On examination his lungs were clear with no abnormal lung sounds (rhonchi, crackles, or wheezes).  A 4 August 2009 NARSUM addendum was completed at the request of the PEB to clarify medication usage.  The examiner confirmed the CI had discontinued Advair and not used albuterol since early April 2009.  The CI reported excellent exercise tolerance and no wheezing or SOB symptoms.  There was no STR evidence that asthma exacerbations were frequent enough to require monthly physician visits.  The CI did not report to the 11 February 2010 VA Compensation and Pension examination.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the asthma condition coded 6602 code (asthma), citing discontinuance of Advair and albuterol and the inability to deploy.  The VA assigned a 0% rating for the asthma condition coded 6602, based on STRs, citing no current medications and that PFT results did not meet minimum criteria for a 10% rating.  There was no PFT evidence (FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent) to support the next higher 30% rating.  Likewise, a 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy or inhalational anti-inflammatory medication at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.    

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

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

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00867.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,