RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01177
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20031121

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

CI CONTENTION:  “Asthma (Developed while Enlisted, Continuous today).” The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel's scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the panel for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 - 20030710	VARD - 20031117	
		
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20030916	
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 had an asthma exacerbation in March 2002 with nocturnal cough, chest tightness, and wheezing that was associated with an upper respiratory infection (URI).  A baseline 21 January 2000 chest radiographic (X-ray) was normal.  The 4 March 2002 pulmonary function tests (PFTs) showed normal spirometry.  The FEV-1 was 116% predicted and the FEV-1/FVC (5.00/5.83) was 86%.  The 6 March 2002 pharmacologic (Methacholine) challenge was consistent with mild bronchial hyper responsiveness.  A 7 March 2002 chest X-ray was normal.  In April 2002, the CI experienced a second exacerbation with a URI.  The CI remained asymptomatic from April 2002 to April 2003, when he had another URI associated with wheezing, cough, and decreased peak flows.  The 14 May 2002 PFTs showed FEV-1 of 113 % predicted and the FEV-1/FVC (4.89/5.79) was 85%.  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 “mild intermittent asthma” for PEB adjudication.  

The 12 May 2003 NARSUM, 6 months before separation, recounted the history and interventions.  The medications listed an inhalational bronchodilator (Albuterol) two puffs four times/day “as needed.”  The NARSUM examiner did not perform a physical examination but recorded the findings of the examination performed on 8 April 2003 during the most recent exacerbation.  The peak flows were 450/450/460 L/min (estimated peak flow for 69-inch, 28-year-old male is 602 L/min).  The lung examination documented “audible wheeze with fine inspiratory wheezing by auscultation.”  The examiner recounted the findings of the normal chest X-ray (March 2002), normal PFTs (March 2002), and Methacholine challenge (March 2002) consistent with mild bronchial responsiveness.  The diagnosis listed mild intermittent asthma.  The examiner documented “his exacerbations are infrequent (usually associated with a URI) and he responded well to inhale bronchodilators.”  

The 16 September 2003 VA Compensation and Pension (C&P) examination, performed 2 months before separation, recounted the history and interventions.  The medications listed “Albuterol inhaler infrequently.”  The lung examination documented “lungs are clear to auscultation bilaterally and there is a symmetric rise and fall without respiratory distress.  No adventitious sounds [abnormal sounds heard over lungs and airways] were auscultated.”  The examiner recounted the findings of the normal chest X-rays (January 2000, March 2002), normal PFTs (March 2002), and Methacholine challenge (March 2002) consistent with mild bronchial responsiveness.  The diagnosis listed mild intermittent asthma.  The examiner documented “Functional Assessment:  Continue on inhalers as needed.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing inability do due his military duties.  The VA rated the asthma condition 0%, coded 6602 (asthma), based on the C&P examination citing PFTs and infrequent requirement for inhalers.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Panel members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the NARSUM and VA evaluations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

PANEL FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01177.

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