RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02097
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050426

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

CI CONTENTION:  “Review all conditions.”  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 - 20050223	VARD - 20070508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Exercise Induced	6602	10%	Exercise Induced Asthma	6602	0%	STR	
Seasonal Allergic Rhinitis	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma, Exercise Induced.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI started developing episodes of bronchospasm in 2003.  She was initially treated with an inhaled bronchodilator (albuterol), but her symptoms were not adequately controlled.  In October 2004 (6 months before separation), Advair (inhaled steroid with bronchodilator, prescribed twice daily) was added to the treatment regimen.  There were numerous subsequent STR entries and automated pharmacy data that corroborated continued use of Advair with appropriate refills.  There were two pulmonary function tests (PFT) in evidence.  Post-bronchodilator measurements of FEV1 were 86% and 82% predicted, and FEV1/FVC ratios were 80% and 88%.  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 CI was referred for an MEB which in turn forwarded “asthma (exercise induced)” to the PEB.  

The NARSUM examination was dated 28 June 2004 (10 months before separation), although much of the content was chronologically later than that date.  One such disconnect was the statement the CI “still notes a small degree of shortness of breath and wheeze [sic] with her current medication regiment [sic] of Advair BID [twice a day] and Albuterol PRN [as needed];” and, the NARSUM medication list included Advair with serial refills through January 2005.  The physical examination recorded clear lungs with full excursion.  The CI failed to report for a scheduled VA examination, and there was no post-separation evidence.
	
The Board 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 (although marginally so by PFT criteria).  This was presumably the basis of the PEB’s rating determination, although a rationale was not cited.  The VA’s 0% rating (based on STR evidence and over 2 years after separation) cited a lack of evidence for current severity.  There was ample evidence that established the regular use of Advair 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 Board recommends a 30% rating for the asthma condition under code 6602.

Contended Seasonal Allergic Rhinitis.  This condition was chronic and well controlled (daily antihistamine) with no STR evidence for any significant acuity at separation.  It was not profiled or implicated in the commander’s statement.  The Board’s main charge was to assess the fairness of the PEB’s determinations the condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Members agreed that there was no performance-based evidence indicating that this condition interfered with duty requirements to an extent that would have prohibited further military service.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the seasonal allergic rhinitis condition; thus, it was not eligible for Service rating.

BOARD FINDINGS:  In the matter of the asthma condition, the Board unanimously recommends a Service disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended seasonal allergic rhinitis condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150721, 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-2015-02097.

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 
cc:
SAF/MRBR