RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01655
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090225

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

CI CONTENTION:  “Please review all my conditions and all my medical records both from the Air Force and from the VA.  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 - 20081016	VARD - 20140418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Intermittent Asthma	6602	10%	Asthma	6602	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the asthma condition began in August 2005 after experiencing chest pain while running outside.  The CI was previously found fit for asthma, but symptoms persisted and second MEB was initiated in June 2008.  The CI complained of dyspnea with running and pushups or sit-ups.  Further treatment did not result in improvement sufficient to allow unrestricted duty.  At the July 2007 Family Practice evaluation the CI reported continued asthma symptoms within 30 seconds of physical training.  The examiner noted that the CI was on Singulair daily and Xopenex (inhaled corticosteroid) as needed.  At this evaluation daily fluticasone (inhaled corticosteroid) was added.  Pulmonary function testing (PFTs) completed in September 2007 were reported to be normal with no response to bronchodilator challenge.  Pulmonary function testing completed in May 2008 showed mild restrictive lung function with FEV and FVC at 89% predicted.

The MEB NARSUM examination on 4 June 2008, 9 months prior to separation, noted complaints of dyspnea with running.  The CI reported he was taking Singulair and felt it helped him with his symptoms.  He also reported taking Xopenex (inhalational bronchodilator) as needed.  The CI also reported he was having difficulty wearing his Self-Contained Breathing Apparatus (SCBA), a requirement for his job.  At the 30 October 2008 Family Practice appointment, the CI complained of persistent wheezing and use of his rescue inhaler (inhaled bronchodilator) on a near daily basis.  Advair (inhaled bronchodilator) was prescribed.  Another C&P examination dated 22 May 2009 referred to asthma medications stating treatment consisted on a regular basis of Advair, Albuterol, and Singulair; however, he had not been using these medications for the last week.  At a 26 June 2009 VA Primary Care evaluation the CI reported daily asthma symptoms which were worse with exercise.  The examiner noted that the CI was on inhaled steroid (Advair and Albuterol).  Singulair was prescribed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing evidence to include PFTs and documented prescribing instructions for medication and record of medication usage.  In October 2009, the VA deferred the asthma rating.  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.”  In its deliberations, the members considered the issue of whether the requirement for daily bronchodilator and/or routine anti-inflammatory therapy was met in this case, as that is the pivotal criteria between a 10% or 30% rating IAW VASRD §4.97.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were prescribed, as noted above.  Panel 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.  There was no PFT evidence to support the next higher 60% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  There were 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; 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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150626, w/atchs
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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01655.

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 XXXXXXXXXXXXXXXXXX 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,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings