RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00142
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060605

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

CI CONTENTION:  “Review all conditions.”  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 - 20060414	VARD - 20100827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20100721	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially presented in January 2004 with a 2 month history of shortness of breath (SOB) associated with exercise.  He was given an Albuterol (bronchodilator) inhaler to use prior to exercise and advised to stop smoking.  The former was successful for several years.  Although he met all in garrison duty requirements, he could not deploy with the diagnosis of asthma and was referred for an MEB in June 2005.  He was referred to pulmonary medicine where a study to evaluate for exercise induced bronchospasm (EIB) showed a positive response consistent with the diagnosis of EIB.  The baseline pulmonary function tests were normal.  The CI was seen in primary care on 21 February 2006 for bronchitis.  He was continued on the Albuterol for the EIB, but an inhaled steroid (Advair) was added for the increased symptoms associated with the bronchitis.  

The MEB NARSUM examination was dated 11 March 2006, 3 months prior to separation.  The CI continued to smoke ½ ppd. and used an inhaler prior to exercise.  An inhaled steroid was not listed as an active medication.  It was also noted that the CI had not been hospitalized or treated in the emergency room for the asthma condition.  On examination, the lungs were clear and he was in no respiratory distress.  On 21 March 2006, the CI requested continuation on active duty (COAD) noting that the asthma condition was of minor severity and that he was able to maintain a high cardiovascular fitness program.  The final clinic appointment in the record was in primary care on 15 May 2006, 3 weeks prior to separation and with a physician’s assistant.  The panel observed that this was less than 2 months after his request for COAD.  The CI reported that his conditions had worsened over the prior few months and that he was waking with wheezing frequently.  This had not been previously recorded.  The CI stated that he had received no benefit from the Advair.  He also desired to quit smoking.  He was given an additional prescription of Advair and Albuterol as well as medications to assist with smoking cessation.  The diagnosis was also changed to mild, persistent asthma.  

There were no additional records in evidence until the VA compensation and pension (C&P) examination which was not performed until 2010, outside the normal probative 12 month window for rating at separation.  The pulmonary functions were normal off medications.  It also noted that the CI had stopped smoking in 2009.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA also coded the asthma condition 6602, but rated it 0% based on the VA C&P examination remote from separation.  The panel considered the evidence.  The record shows that the CI was evaluated multiple times in the pulmonary clinic and diagnosed with EIB based on spirometry, history, a methacholine challenge test, and a provocative test for EIB.  Use of a bronchodilator was prescribed prior to exercise for the majority of the record.  Shortly before the MEB, an inhaled steroid was added, but to treat an overlying infection (bronchitis).  Subsequently, this was refilled shortly before separation and the diagnosis changed by a physician’s assistant.  The panel observed that the history provided by the CI at this evaluation was not consistent with that included in his request for COAD less than 2 months previously.  It was also noted that at the VA C&P examination, albeit remote from separation, the CI was not recorded as being on medications and had normal pulmonary function testing.  The preponderance of evidence supported the PEB adjudication of a 10% rating for “intermittent inhalational or oral bronchodilator therapy.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.100, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160222, 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-2016-00142.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings