RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01971
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050701

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

CI CONTENTION:  The CI requested a review of 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 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 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 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 - 20050516	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma 	6602	10%	No VA Examination in Evidence	
Overweight 	Cat III		
Tobacco Abuse	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  The probative evidence for this case was limited to outpatient clinical entries from the service treatment records (STR).  The narrative summary and contemporary history and physical (DA Forms 2807-1 and 2808) were missing from the Medical Evaluation Board (MEB) documents, and could not be retrieved after repeated attempts.  Additionally there was no VA claim, examination, treatment notes, or other post-separation evidence.  The details of the onset and clinical course of asthma were not available, although the diagnosis was not documented on the enlistment examination.  Earlier STR entries recorded the use of albuterol (inhaled bronchodilator) as needed.  Although there was no entry that documented its indication or initial prescription, there was record of a telephone encounter on 5 May 2005 (2 months before separation) that documented accommodation of a refill request for Flovent (an inhalational steroid anti-inflammatory).  There were three subsequent entries (including an emergency department evaluation of abdominal pain 2 weeks before separation) that listed albuterol and Flovent (twice daily) with current medications.  There was no contrary evidence or indication that the CI was not using both of these medications at the time of separation.  

There were 2 pulmonary function tests (PFT) in evidence.  Measurements of FEV1 were 80% and 84% predicted, and FEV1/FVC ratios were 95% and 97%.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  Continued treatment did not result in sufficient improvement to allow unrestricted duty and the MEB forwarded “asthma (exercise induced)” for PEB adjudication

The panel directed attention to its rating recommendation based on the above evidence.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under code 6602 (asthma).  The 6602 criteria for a rating higher than 30% were not in evidence as above.  The criteria for the ratings under consideration are: 30% - “FEV-1 of [56-70%] predicted, or; FEV-1/FVC of [56-70%], or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication;” and, 10% - “FEV-1 of [71-80%] predicted, or; FEV-1/FVC of [71-80%], or; intermittent inhalational or oral bronchodilator therapy.”  A 10% rating is supported by the PFT and intermittent bronchodilator criteria in this case.  This was presumably the basis of the PEB’s rating determination, although a rationale was not cited.  There was, however, convincing STR evidence for the regular use of Flovent at separation; and, the latter satisfies the 30% “inhalational anti-inflammatory medication” criterion of 6602.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 30% rating for the asthma condition under code 6602.

Contended PEB Conditions:  Overweight; Tobacco Abuse.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended overweight and tobacco abuse conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150716, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01971.

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