RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02184
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050315

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

CI CONTENTION:  The CI made no specific contention.  The 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 - 20050214	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	N/A				
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  --N/A	

ANALYSIS SUMMARY:  

Asthma Diagnosis. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition was diagnosed in March 2004 following a methacholine challenge test.  The CI had reported shortness of breath with activity and rest for one and one-half years prior.  The CI was started on Albuterol (bronchodilator) inhaler as need, but continued to be symptomatic.  Flovent Inhaler (inhalation anti-inflammatory) was added.  In August 2004, the CI’s medication was changed to Advair inhaler (inhalation anti-inflammatory) and Singulair (oral indirect-acting bronchodilator) daily.  The albuterol inhaler was continued as needed.  The CI remained stable, but rarely participated in athletic events or exercises outside his duty requirements.  

At the 13 August 2004 MEB Specialty Care Pulmonary examination, 7 months prior to separation, the CI detailed his asthma condition did not keep him from doing his job; however, he was having problems with his physical fitness training.  The CI stated that he developed shortness of breath, chest tightness, and occasional wheezing.  Physical examination showed the lungs clear to auscultation bilaterally.  Pulmonary function test showed FVC 96% predicted and FEV-1 79% predicated.  Methacholine challenge test showed moderate degree of airway hyperactivity consistent with asthma.  Medications included Advair twice daily, Singulair daily, and Albuterol as needed.  

The 13 October 2004 MEB NARSUM examination, 5 months prior to separation, the CI’s asthma was well controlled.  No ER or acute clinic visits for asthma flare-ups were reported.  The CI reported rarely using his Albuterol inhaler.  Physical examination showed the chest was clear to auscultation, no wheezing, no rhonchi, and no rales.  Medication included Advair 250/50mg twice daily, Singulair daily, and Albuterol as needed.  There was no VA Compensation and Pension (C&P) evaluation in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  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.”  Panel members considered that the Pulmonary Medicine and MEB examinations reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision, were also required, as noted by the examiners.  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.  
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 §4.100.  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 20150731, w/atchs
Exhibit B.  Service 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-2015-02184.

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.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I 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.  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