RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01510
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060926

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

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 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 - 20060809	VARD - 20070426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Exercise Induced Asthma	6602	10%	20070131	
Morbid Obesity	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with asthma after an abnormal pulmonary function test (PFT) was performed in February 2006.  Previously, the CI received prescription medications of an inhaled bronchodilator (Albuterol) and an inhaled corticosteroid (Advair) to treat his symptoms of shortness of breath.  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 “exercise induced asthma” for PEB adjudication.

On 2 June 2006, 4 months prior to separation, the CI was seen by pulmonology who listed the diagnosis as “exercise-induced bronchospasm.”  Specifically, the provided documented “He [the CI] has not used any inhalers and his spirometry is normal today.  I suspect he may have very mild asthma and given his nasal inflammation I started him on Singulair 10 mg daily.  In addition, I encouraged him to use albuterol 10 to 15 minutes before exercise.” 

One week later on 9 June 2006, a primary care clinical encounter although listed Singulair under “active medications,” the provider noted the following under history of present illness; “[The CI] was given Advair for a while and he states this helped some.  [The CI] also instructed to use the Albuterol prior to exertion but this has not helped and Singulair also has not helped.”  The MEB NARSUM examination on 12 June 2006, 3 months prior to separation, noted complaints of shortness of breath and chest tightness with running.  Current medications were documented as Advair, Singulair, and Albuterol.  His physical examination (PE) was unremarkable.  A clinical encounter dated 06 September 2006, 3 weeks prior to separation, indicated that the CI was “using Albuterol for newly diagnosed exercise asthma,” as listed under “Chief Complaint.”    

At the 31 January 2007 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported he used Albuterol inhaler as needed when exercising.  Additionally, the CI reported that he had never used oral therapy and had previously used Advair, but currently “doesn’t have.”  Repeat PFT’s done on 13 February 2007, 5 months after separation, were normal as measured pre-bronchodilator therapy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma condition 10%, coded 6602, based on the VA C&P examination, citing use of Albuterol as needed when exercising and normal PFTs.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  The non-PFT derived criteria under 6602 are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; non-daily inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%.  Absent evidence of oral corticosteroid use (60% rating), Panel members deliberated if the CI’s condition supported either the 10% or 30% impairment rating.  From an objective PFT standpoint, the normal spirometry values, both pre and post separation, did not support a rating under that criteria.  In its deliberations, panel members considered the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory (steroid) therapy was met in this case.  The panel carefully reviewed all lists of active medications and weighed the probative value with other evidence found within the STR as well as the CI’s statement of medication use.

The CI continued to report the use of Albuterol on an as needed basis, but as reported on the pulmonary consultation in June 2006, he discontinued the use of Advair in March 2006, 6 months prior to separation.  Although the NARSUM examination listed Advair under current medications, (10 days after the pulmonology examination), the Panel saw no evidence of the CI receiving such steroid medication during the 10 day interval between the two examinations.  Additionally, even though the indirect oral bronchodilator of Singulair remained listed as an “active medication” in the clinic’s computer system, the CI’s own comments of Albuterol use only weeks prior to separation as well as noting a history of never using oral therapy at the VA examination lent support to rate according to criteria of intermittent inhalation therapy.  Therefore, based upon the above rationale, panel members agreed that the PEB’s 10% rating was justified by the intermittent use of an inhaled bronchodilator as reflected in the STR and the NARSUM.   

Contended PEB Condition:  Morbid Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Obesity is a condition 
recommending this condition as additionally unfitting for separation rating.  

PANEL FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the Panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended morbid obesity condition, the Panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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-2015-01510.

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,

						
XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings