RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00702
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20040728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Services Apprentice, medically separated for “asthma” with a disability rating of 10%.

CI CONTENTION:  Review the back condition.  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 - 20040412	VARD - 20040720	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6200	30%	20040608	
Back Pain	Cat II	Disc Bulges T6-7, T7-8	5234	10%	20040608	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition was diagnosed in September 2003 after reporting a 6-month history of recurrent dyspnea (difficult breathing) on exertion.  A cardiology evaluation was unrevealing, but asthma was diagnosed based on two positive histamine challenge tests.  The 14 January 2004 MEB NARSUM examination, 6 months prior to separation, noted the CI was taking albuterol as needed, Advair daily (inhaled anti-inflammatory medication) and Singular nightly, without symptom control.  Her pulmonary examination was normal.  

At the 8 June 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported she was taking Advair, Singulair and albuterol intermittently.  The CI was seen in primary care on 28 June 2004, 1 month before separation, and reported the only medication she was taking was albuterol once a week.  The current medication profile listed albuterol, Advair and Singular, but all refills remained.

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 rated the asthma condition 30%, coded 6602, based on the C&P examination 2 months before separation, citing VASRD criteria.  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 the MEB NARSUM and VA examinations which reported the prescription and use of an inhaled anti-inflammatory medication.  The panel also considered the primary care examination, 1 month prior to separation, which listed Advair as an active medication, but the last time it had been filled was 3 December 2003 (8 months prior to separation).  The panel majority agreed the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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.  There was no pulmonary function testing conducted proximate to separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the asthma condition, coded 6602.

Contended PEB Condition:  Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination the contended condition was not unfitting.  The contended condition was not specifically profiled or implicated in the commander’s statement.  The neurological examination was normal and thoracic and lumbar spine MRIs were normal.  No etiology for the pain was found.  The MEB listed thoracic and lumbar pain among multiple conditions referred to the PEB.  There was no evidence of back pain affecting duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the asthma condition, the panel majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows; and, 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 20160914, 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 Applicant: 

   Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00702. 

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

 I have 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