RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00226
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051024

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

CI CONTENTION:  The CI contends posttraumatic stress disorder and migraines which are addressed in the “scope of review” below.  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 - 20050909	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI complained of “chest tightness and wheezing” in April 2005 when running.  She had also noted that she coughed up blood when running the previous June; it was attributed to a pulmonary infection.  At the April 2005 visit, she was prescribed Albuterol (a broncho-dilator) and then Advair (an inhaled steroid) at a follow up appointment in May with an improvement in her symptoms.  Pulmonary function testing, on medications, was normal on 18 July 2005.  A Methacholine challenge test was done on 20 July 2005 was positive, but not until level 6 (of 7).  She was diagnosed with exercise induced asthma.  

The MEB NARSUM examination was dated 21 July 2005, 3 months prior to separation, noted that the CI was using Advair daily, and albuterol as needed with significant symptom improvement.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  The CI was seen frequently in the months prior to separation, but this was for initial treatment and diagnosis.  One month prior to separation, on 16 September 2005, the CI was seen for a medication refill and continued on both Advair and albuterol inhalers.  She was dispensed a 1 month supply with 5 refills.  

Following separation, the CI was seen in the VA system for both migraines and fainting (syncope) on multiple (at least 6) occasions in the first 12 months following separation.  The use of asthma medications was not recorded at any of these encounters, although other medications were documented.  It was noted that following separation, the CI moved from Missouri to Colorado.  The panel observed that individuals with asthma can be asymptomatic in some locations and symptomatic in others.  The CI denied a history of asthma at accession (in the UK) and again did not seek treatment for the asthma following separation and a move to a new geographical location.  A VA noted dated 22 August 2008 noted that she again had become symptomatic as she had run out of her military issued inhalers.  A subsequent note from the Kansas City VAMC, remote from separation, indicated that she used albuterol about once a week and had used it less in Colorado.  No VA Compensation and Pension (C&P) evaluation was performed 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, citing Department of Defense and Veterans Administration Schedule for Rating Disabilities guidelines.  The VA rated the asthma condition 10%, coded 6602, approximately 10 years after separation citing intermittent inhalational therapy.  The panel considered the evidence.  The criteria for a 10% rating include the use of an inhaled bronchodilator on an intermittent basis and the CI clearly met this.  For a higher 30% rating, the criteria include the daily use of an inhaled bronchodilator or the use (any frequency) of an inhaled anti-inflammatory medication.  Prior to separation and prior to moving, the CI met the criteria for a 30% rating.  Following separation, the records did not document the continued use of any medications and there was not a record of a medication refill for almost 3 years.  At that appointment, she indicated that she had run out of the military issued medications.  The records in evidence reported current prescriptions and use of an inhaled anti-inflammatory medication proximate to separation.  The panel majority agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator and/or inhalational anti-inflammatory medication use.  The panel carefully reviewed the post-separation evidence which indicated that the CI was not using any medications for asthma even though other medications were documented.  The panel universally opined that the evidence was consistent with a 0% rating following separation, but the majority determined that, with consideration of VASRD §4.3 (reasonable doubt), a 30% rating was supported by pre-separation evidence.  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.  In addition, 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 panel recommends a disability rating of 30% for the asthma condition, coded 6602.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel majority recommends a disability rating of 30%, coded 6602, IAW VASRD §4.100.  The single voter for dissent recommends no change and submitted the appended minority opinion.  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 20160412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MINORITY OPINION:  

While it is clear from the record that the CI was prescribed Advair prior to separation, it is less clear that the CI actually used or even needed this or other asthma medications at the time proximal to separation.  Asthma is a condition in which an individual can be symptomatic in one geographic location and asymptomatic in another.  In this case, the CI moved to CO from MO around the time of separation.  In the first 12 months following separation, the CI was seen in the VA system on multiple occasions.  Although the use of other medications was documented, the use of asthma medications was not recorded at any of these encounters.  In fact, there was not a record of an asthma medication refill for almost 3 years, which would indicate that the asthma medications were not required, and the criteria for a 30% rating were not met.  

For a 30% rating, the criteria include the daily use of an inhaled bronchodilator or the use of an inhaled anti-inflammatory medication.  The PDBR DoDI 6040.44 authorizes the panel to consider evidence up to 12 months post separation in their deliberation.  The evidence following separation clearly does not support either of these criteria for at least a year after separation.  

Consistent with the DoDI 6040.44 standard that Physical Disability Board of Review recommendations are fair and equitable to both the Service and the CI, the Secretary is respectfully requested to consider the minority recommendation that the PEB adjudication for the asthma condition, coded 6602, stand unchanged at 10%.  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	10%	

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-2016-00226.

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 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