RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00989
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061128

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

CI CONTENTION:  The CI contends for his unfitting asthma and a condition not identified by either the MEB or PEB.  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 – 20061017	VARD - 20101006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20100521	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition was noticed in July 2004 when being examined for his annual periodic health assessment in conjunction with an occupational examination.  The CI worked painting aircraft and had significant occupational exposure to diisocyanates, chemicals well known to cause occupational asthma, as well as other chemicals and fumes.  The CI was treated with daily steroid and bronchodilator (BD) inhalers without control of his symptoms.  Methacholine challenge testing in April 2006 was consistent with a diagnosis of asthma.  The MEB forwarded “mild intermittent asthma” for PEB adjudication.  

On 5 June 2006 (6 months prior to separation), pulmonary function testing (PFTs) were normal.  
On 7 August 2006 (4 months prior to separation), PFTs showed an FEV-1 of 82% PRED and an FEV-1/FVC of 79% PRED (normal for both FEV1 and FEV1/FVC 80% PRED or greater).  A pulmonary evaluation on 8 August 2006 noted that the CI had been removed from exposure to diisocyanates and had near complete resolution of his symptoms on his current medications which included an inhaled steroid, an oral anti-inflammatory/bronchodilator medication, and use of a BD inhaler as needed.  The CI had been removed from all profile restrictions except exposure to diisocyanates. The pulmonologist noted that at the time of follow-up, discontinuation or decrease of medications would be considered “given that he may have resolution of symptoms after being removed from his former occupational environment.”  

The MEB NARSUM examination on 6 September 2006, 3 months prior to separation, noted that the CI was asymptomatic but taking daily Advair (inhalational steroid/bronchodilator combination), Singulair (oral indirect-acting bronchodilator), and Albuterol (inhalational bronchodilator) as needed.  The physical exam of the lungs was normal without wheezing noted. Review of the STR found no clinical encounters 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.  At a visit to establish care at the VA on 31 March 2010, the CI reported his asthma was flaring up.  He reported he had been using only a rescue inhaler as needed.  He had not been to the emergency room or required admission for asthma symptoms recently.  Chest X-ray and PFTs performed in April 2010 were normal.  

At the 21 May 2010 VA Compensation and Pension (C&P) evaluation, performed 3 years and 6 months after separation, the examiner noted that the CI had not required treatment for asthma since discharge until 31 March 2010.  The CI reported shortness of breath several times per day which he related to being out of condition.  At the time of the C&P examination he was taking daily Asmanex Twisthaler (steroid inhaler) daily and Albuterol inhaler as needed.  The physical exam of the lungs was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing VASRD guidelines.  The VA rated the asthma condition 30%, coded 6602, citing daily inhalational or oral bronchodilator therapy.  At the remote VA C&P examination the CI indicated he was using a BD inhaler as needed and had not required treatment for asthma from the time of military discharge to March 2010, 40 months after separation.  The Board noted that this was consistent with significant improvement or resolution of the asthma induced by chemical exposure upon removal from the exposure as anticipated by the pulmonary specialist.  At the time of the C&P exam, 42 months after separation, the CI had apparently been recently prescribed a steroid inhaler again for an asthma flare-up.  The Board concluded that the evidence supports that proximate to separation the CI’s asthma was greatly improved by removal from his occupational exposures in aircraft maintenance and the disability due to the asthma condition was more nearly approximated by the 10% rating for intermittent use of a BD inhaler, than the 30% rating IAW VASRD 4.7 (Higher of two evaluations).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that 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 or majority 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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00989.

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,

Attachment:
Record of Proceedings