RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01076
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces Journeyman, medically separated for “asthma,”  with a disability rating of 10%.  

CI CONTENTION:  The CI requests consideration of all conditions.  The 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 - 20060815	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma 	6602	10%	No VA examination in evidence	
OSA Requiring CPAP	6847 	Category II		
Chronic Right Knee Pain…	5257	Category II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY: 

Asthma.  Although the CI first developed intermittent respiratory symptoms in 2005, the diagnosis of mild reactive airway disease was established by a pulmonologist in June 2006.  The CI was started on an inhalational anti-inflammatory medication (Advair) twice daily and a bronchodilator (Albuterol) as needed.  

According to the Pulmonary clinic evaluation on 8 June 2006, approximately 4 months prior to separation, the examiner noted that the CI was having good response to prescribed Advair twice daily and Albuterol as needed.  Pulmonary function tests (PFTs) were consistent with mild restrictive airway disease (FEV1-69% predicted, FEV1/FVC-82% predicted, with measureable improvement in both parameters post bronchodilation therapy).  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.  The MEB forwarded “asthma” for PEB adjudication.  

The MEB NARSUM examination on 12 June 2006, approximately 4 months prior to separation, noted complaints of mild shortness of breath with a non-productive cough.  Physical examination showed lungs with a fair bilateral expansion without wheezes, rhonchi or crackles.  Review of the Service Treatment Record (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 VA Compensation and Pension examination in evidence.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (Asthma, bronchial).  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.”  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also prescribed and used, as noted by the Pulmonary and MEB NARSUM examiners.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or 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.  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.  

Contended PEB Conditions:  OSA Requiring CPAP, Chronic Right Knee Pain….  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  

OSA Requiring CPAP.  A sleep study was performed in January 2006 to evaluate complaints of snoring, witnessed episodes of apnea (breathing cessation) during sleep, daytime fatigue, sleepiness, morning headaches, and difficulty thinking in the early morning.  The study confirmed the diagnosis of mild OSA when the CI was in a supine position.  At the Pulmonary clinic appointment on 8 June 2006, approximately 4 months prior to separation, the CI reported that he was able to sleep about 6 hours each night with the CPAP mask and felt much better during the day.  The examiner noted that the CI was much less sleepy.  The MEB NARSUM examiner on 12 June 2006 approximately 4 months prior to separation, noted that the CI had undergone 2 sleep studies which confirmed the diagnosis of mild sleep apnea and a trial of CPAP in early June resulted in a good response.  

The commander’s statement on 13 June 2006 noted that the CI’s “condition/medical appointments/treatment has forced him to miss work, and has adversely affected the operation of his duty section.”  There was no mention of symptoms suggestive of OSA interfering with duty performance, i.e., inability to concentrate, falling asleep during task, making simple errors, etc.  He was given a P4 profile on 23 June 2006; however, no specific condition was mentioned but restrictions appears to relate to his knee condition and possibly the asthma.  In consideration of these facts, after due deliberation, the Board agreed there was not a preponderance of evidence with regard to the functional impairment of OSA to recommend a change in the PEB adjudication.

Chronic Right Knee Pain.  According to the STR and the MEB NARSUM, the CI’s right knee condition began in May 2004 after running during technical school.  He underwent a right knee arthroscopic lateral release on 18 November 2005.  The Commander’s Statement on 13 June 2006 noted that the CI’s “condition/medical appointments/treatment has forced him to miss work, and has adversely affected the operation of his duty section”.  He was given a L4 profile on 23 June 2006 with restrictions of limited running, no lifting, pushing, or pulling greater than 20 pounds and no standing for more than 1 hour a day.  At the Physical Therapy (PT) evaluation on 18 May 2006, the CI reported chronic right knee pain with activity.  The range of motion (ROM) for flexion was limited to 20-114 degrees (normal 140 degrees).  At the orthopedic evaluation on 23 May 2006, the examiner noted that a repeat right knee MRI did not show any new pathology.  He further noted that the CI had residual symptoms from weakness of his quadriceps muscle.  The MEB NARSUM examiner on 12 June 2006 approximately 4 months prior to separation, documented that the CI had significant duty restrictions as a result of his right knee condition.  There was no examination of the right knee.  The PEB rated the chronic right knee pain condition as a Category II coded 5257 (Knee, other impairment of).  The Board first considered the fitness of the right knee condition.  The Board reviewed the evidence that the CI was placed on a L4 profile with restrictions of no lifting, pushing, or pulling greater than 20 pounds and no standing for more than 1 hour a day.  The MEB NARSUM examiner documented that the CI significant duty restrictions as a result of his right knee condition.  Based on a thorough review of the evidence, the Board majority agreed that the right knee condition was unfitting.  

The Board then directed its attention to rating the right knee condition.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) as the CI underwent a lateral release only,  to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The Board agreed that the 5099 analogous to 5003 Arthritis, degenerative (hypertrophic or osteoarthritis) more closely aligned with the CI’s condition.  After due deliberation, the Board majority agreed that the preponderance of the evidence with regard to the functional impairment of right knee pain contended condition favors its recommendation as an additionally unfitting condition for disability rating,  coded 5099-5003 and meets the VASRD §4.71 criteria for a 10% rating.  

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  In the matter of the contended OSA condition, the Board recommends no change from the PEB determination as not unfitting.  In the matter of the chronic right knee pain contended condition, the Board majority agrees that it was unfitting and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter of dissent did not elect to submit a minority opinion.  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%	
Chronic Right Knee Pain…	5099-5003	10%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, w/atchs
Exhibit B.  Service Treatment Record

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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01076.

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 at XXXXXXXXXXXXXXXXXXX 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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings