RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00585
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040806

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Jet Engine Aerospace Propulsion Journeyman, medically separated for “asthma…” with a disability rating of 10%.  

CI CONTENTION:  Asthma condition has worsened.  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 - 20040528	VARD - 20050725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma…	6602	10%	Asthma	6602	10%	20050604	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s had a history of wheezing and coughing following a cold in August 2002, which was diagnosed as bronchitis and chest tightness and was treated with an antibiotic (azithromycin), cough medication (guaifenesin), a nonsteroidal anti-inflammatory drug (NSAID), albuterol (a bronchodilator) and intravenous fluids.  A chest X-ray series, ordered for intermittent sharp chest pain in the mid-sternum with deep breaths occurring at bedtime, was normal in September 2003.  Pulmonary function testing in October 2003 revealed a mild degree of small airway disease with a post bronchodilator FEV1 of 96% predicted and FEV/FVC 103% predicted.  In February 2004 based on history the impression of probable mild, intermittent cough variant asthma was made with gastroesophageal reflux disease (GERD) exacerbating the condition.  Treatment was with Advair (fluticasone, a steroid, and salmeterol, a bronchodilator) and Prevacid (lansoprazole, a proton-pump inhibitor)).  Pulmonary function studies on 24 February 2004 revealed an FEV 1 of 46% predicted and an FEV1/FVC of 56% with a positive bronchodilator response yielding an FEV1 of 70% predicted and FEV1/FVC 66%. The CI was also noted to have had an esophageal foreign body obstruction on 27 February 2004 after he swallowed a large protein pill that lodged in the esophagus, which was removed by endoscopy.  A repeat procedure about a month later showed a probable Schatzki’s ring (of mucosal or muscular tissue) at the gastroesophageal junction that required dilation. 

The 11 March 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of a history of a nocturnal wheezing and coughing, especially when supine and chest tightness after exercise.  The CI noted occasional GERD symptoms after spicy foods and had seasonal allergic rhinitis especially in the spring and summer.  He used albuterol 3 times per week.  Physical examination showed his chest to be clear bilaterally throughout with the exception of bilateral basilar inspiratory musical wheezes, right greater than left.  The examiner’s impression was mild persistent asthma, gastroesophageal reflux disease, and seasonal allergic rhinitis by history, not currently active.  The examiner noted the continuation of albuterol as needed and Advair use twice per day.  The 15 April 2004 MEB NARSUM Addendum, 4 months prior to separation, noted the CI’s symptoms had improved using Advair.  The CI was also using albuterol 2 to 3 times per week before exercise.  The physical examination showed no wheezing, or rhonchi.  The examiner opined that the CI’s condition was better controlled with Advair.  He subsequently did well with the GERD with Prevacid (lansoprazole, a proton-pump inhibitor).  Physical examination showed the lungs to be clear to auscultation without crackles, wheezes, or rhonchi.

At the 4 June 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported good symptomatic relief with medication. Physical examination showed no wheezing or rhonchi.  The examiner noted that the CI’s asthma and reversible airway disease were medically managed.  It was noted that the CI was taking Advair and albuterol for the asthma and his nighttime symptoms of heartburn were controlled with medication.  Pulmonary function testing on 3 June 2005 was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma associated with esophageal reflux condition 10%, coded 6602 (asthma).  The VA rated the asthma condition 10%, coded 6602 (asthma), based on the C&P examination 2 months before separation, citing FEV-1 of 71 to 80 percent predicted and FEV1/FVC of 71 to 80 percent predicted.  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.”  The NARSUM, STR, and VA C&P examinations all noted the CI was prescribed Advair for daily use.  Advair, in addition to being an inhalational bronchodilator (salmeterol), also contains an inhalational anti-inflammatory medication (fluticasone); therefore, a 30% rating is warranted.  The PEB also noted the asthma was associated with esophageal reflux.  Panel members determined the esophageal reflux was not separately unfitting, but contributed to the asthma, and the esophageal reflux was adequately controlled by diet and Prevacid.  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 §4.97.   There are 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 20160912, 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-2016-00585.

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,

Attachment:
Record of Proceedings