RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01965
BRANCH OF SERVICE:  AIR force 	SEPARATION DATE:  20040116

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

CI CONTENTION:  The CI did not submit a contention in the application.  The CI’s 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 - 20031113	VARD – 20040922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20040511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began on 23 June 2003 when she presented to the medical clinic  complaining of episodes of not being able to “catch her breath,” even at rest.  The CI was sent that day for methacholine challenge testing, which was “highly positive,” and the pulmonologist confirmed a diagnosis of mild persistent asthma.  Treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “mild persistent asthma” for PEB adjudication.  On 4 September 2003, 4 months prior to separation, post-bronchodilator pulmonary function testing (PFTs) showed an FEV-1 of 61% of predicted and an FEV-1/FVC of 97%.  

The MEB NARSUM examination on 13 November 2003, 2 months prior to separation, noted that the CI was taking Pulmicort Inhaler (inhalational anti-inflammatory) once daily, Serevent Diskus (inhalational bronchodilator) twice a day, and Proventil Inhaler (inhalational bronchodilator) - 15 minutes prior to any form of activity.  The DD Form 2697, Report of Medical Assessment, dated 9 December 2003, 1 month prior to separation, showed the CI reported medication use of Singulair, Serevent and Pulmicort inhalers.  

At the 11 May 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the examiner noted that the CI was using an “albuterol inhaler one to two puffs about two times during wheezing attacks” and “denies taking any other medications” other than birth control pills.  PFT’s showed an FEV-1 of 88 percent of predicted and an FEV-1/FVC of 103 percent.  VA records cited VA outpatient treatment records, dated 5 August 2004, 7 months after separation, indicating the CI was prescribed and advised to use four puffs of Azmacort (inhalational anti-inflammatory) twice a day.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing “DoD and VASRD guidelines.”  The VA rated the asthma condition 10%, coded 6602, citing the 10% criteria, based on their exam 4 months after separation.  The VA increased the 6602 rating to 30% effective to the day after separation, based on additional STR information and the CI’s civilian pulmonologist’s records through September 2004, citing medication use and the 30% rating criteria.  Board members considered that the examinations in evidence reported current prescription and use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision.  Board members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication prescription.  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 3 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 Board recommends a disability rating of 30% for the asthma condition, coded 6602.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150919, with 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-2015-01965.

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 

cc:
SAF/MRBR