RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01314
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Metals Technology Journeyman, medically separated for “asthma,” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 Board 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 determination 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(s) 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 - 20060817	VARD - 20071127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Mild Persistent	6602	0%	Asthma	6602	0%	20070621	
Tobacco Abuse	Cat III	No VA Placement	
Hyperlipidemia	Cat III	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY 

Asthma.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in May 2005 for a history of recurrent wheezing and the need for a respirator while welding.  A diagnosis of asthma was made based on pulmonary function testing (PFT) and clinical presentation.  Medications prescribed included inhaled bronchodilators (Albuterol) “as needed” basis, oral bronchodilators (Singulair) for daily use, and inhalational bronchodilators (Serevent) twice daily.  In June 2006, inhaled steroids (Advair) were prescribed for twice daily use.  

According to the pulmonary clinic evaluation on 9 June 2006, 4 months prior to separation, the examiner noted that the CI had been off the Singulair (oral bronchodilator) for 1 month and did not notice any change in his condition.  The medication list was updated to include Albuterol as needed; Serevent twice daily; and Singulair daily.  According to the family practice clinic evaluation on 20 June 2006, 4 months prior to separation, the examiner noted that the CI was only using the Albuterol and not the prescribed Serevent and Singulair.  According to the asthma outpatient documentation, dated 22 June 2006, 4 months prior to separation, the CI indicated he was using albuterol, 2 puffs, 4 times daily.  Entries for inhaled steroids or Salmeterol (inhaled bronchodilator) were left blank. 

The 17 July 2006 MEB NARSUM examination, 3 months prior to separation, noted that the CI was not taking his asthma medications as prescribed.  Medication regimen was changed to Advair twice a day and Albuterol as needed.  On examination there was no wheeze or rhonchi. I Inspiratory and expiratory effort was normal.  At the 18 September 2006 separation physical, 1 month prior to separation, the active medications section listed what appears to be a generic form of Advair (inhaled steroid/inhaled bronchodilator prescribed on 22 June 2006).  17 A spirometry test in December 2006, 2 months post-separation, noted FVC 84 % predicted and FEV1 68 % predicted.  Mild restriction with moderate obstruction was noted.  Review of the service treatment records (STR) found no clinical encounters in evidence documenting the use of an oral or parenteral steroids 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 the 21 June 2007 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported the Singulair and Advair were not helping and that he was no longer taking either medication.  The examiner noted that the CI had occasional shortness of breath, but the only medication he was taking was Albuterol “for wheezing a couple times a week.”  Results from the pulmonary function test (PFT) showed a post-bronchodilator FEV-1 of 111.5%.  The actual PFT results were not included in the C&P examination.  The examiner concluded that the CI had “no medical condition that would cause any impairment in his activities of daily living or prevent employability.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 0%, coded 6602 (asthma), with likely application of DoDI 1332.39 rating guidance in effect at the time.  The VA rated the asthma 0%, coded 6602 (asthma), based on the C&P examination 8 months after separation, citing rare inspiratory wheeze without rhonchi, rales or prolongation of the expiratory phase.

Panel members agreed that a 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the STR.  The 10% rating stipulates “FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.  A 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  There was no PFT evidence to support the next higher 30% rating.  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.  

Contended PEB Conditions: Tobacco abuse and hyperlipidemia.  In accordance with DoDI 1332.38, Enclosure 5, paragraph E5.1.3.9.1, tobacco abuse is a condition not constituting a physical disability and is not ratable.  Hyperlipidemia is an abnormal laboratory finding and not a physical disability.  Therefore it is not ratable.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 10%, coded 6602 IAW VASRD §4.100.  In the matter of the contended tobacco abuse and hyperlipidemia conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01314.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR