RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00297
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Command Post Journeyman, medically separated for “chronic cough, (Bronchitis)” 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20041022	VARD - 20050728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Cough (Bronchitis)	6600	10%	Exertional Asthma	6602	10%	20050613	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Cough (Bronchitis).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic cough condition began in 2003 after moving to Hawaii.  The CI reported a chronic cough and shortness of breath with chest tightness on exertion.  She was treated with allergy medications, which provided no benefit.  An albuterol inhaler was prescribed which was helpful and an anti-inflammatory inhaler and additional anti-inflammatory/allergy medications were added.  Pulmonary function testing (PFT) performed on 30 July 2003 was normal and methacholine challenge test performed 15 October 2007 was negative.  Imaging of the chest, including radiographic (X-rays) and computed tomography was normal. The CI was evaluated by cardiology and otolaryngology (ear, nose and throat) and no cause for the cough and shortness of breath with exertion was identified.  

The 25 August 2004 MEB pulmonary consult determined that asthma had been ruled out as a diagnosis and stopped the anti-inflammatory inhaler use and the albuterol inhaler was continued due to reported symptomatic improvement.  Medication for gastroesophageal reflux disease (GERD) was prescribed and the CI was advised to have an evaluation by gastroenterology for GERD.  The 22 September 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic cough associated with chest tightness on exertion.  Physical examination showed normal respirations.  The CI was able to speak in full sentences with a frequent dry cough.  Examination of the heart and lungs was normal.  

The original VA Rating Decision summarized the findings of the 13 June 2005 VA Compensation and Pension (C&P) evaluation.  The CI reported shortness of breath at rest aggravated with with walking a few blocks.  Since military separation, she reported she was not performing routine exercise and used the albuterol inhaler only intermittently, before exertion.  The CI denied frequent infection, use of an anti-inflammatory inhaler, steroid therapy, or use of immunosuppressive medication.  She was not using oxygen and had not experienced respiratory failure.  Physical examination of the heart and lungs was normal.  Chest X-ray was normal and pulmonary function testing showed a forced expiratory volume in one second (FEV-1) of 71% predicted normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic cough condition 10%, coded 6600 (chronic bronchitis).  The VA rated the cough condition 10%, codded 6602 (asthma), citing the FEV-1 of 71%.  The PEB assigned a 10% rating under 6600, therefore the panel reviewed to see if a higher rating was supported with any applicable VASRD code.  There was no PFT evidence to support the 30% rating or evidence of any criteria required to meet the threshold for higher ratings.  The panel also considered if a higher rating was supported coded analogously to 6602.  A 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  A higher rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations or at least three courses of systemic corticosteroids per year.  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 chronic cough condition.  

BOARD FINDINGS:  In the matter of the chronic cough, (bronchitis) condition and IAW VASRD §4.97, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20160514, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Rating Decision

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-2016-00297.

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,

Attachment:
Record of Proceedings