RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00858
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Ground Equipment, 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 - 20050429	VARD - 20050107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20041018	
Overweight	Cat III	No VA Exam in Evidence	
Tobacco Abuse	Cat  III	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented for treatment in January 2004 with the complaint of persistent dyspnea (shortness of breath).  The CI reported in 1999 he had an episode of bronchitis and pneumonia and was given albuterol (an inhalational bronchodilator) at that time, which had been used on an as needed bases (two to three times a week).  He reported his dyspnea was triggered by dust and exercise.  Pulmonary function studies (PFTs) dated 5 February 2004 revealed an FEV1 (forced expiratory volume at 1 second) of 84% predicted and post-bronchodilator 82% predicted and an FEV1/FVC (forced vital capacity) of 77% and post bronchodilator 80%.  Follow-up PFTs on 10 February 2004 revealed an FEV1 of 75% predicted and 89% post bronchodilator and FEV1/FVC of 82% and post bronchodilator 79%, which was interpreted as minimal obstructive airway disease responsive to a bronchodilator.  An additional PFT study on 17 February 2004 revealed an FEV1 of 73% predicted and 92% post-bronchodilator and an FEV1/FVC of 77% and post bronchodilator 82%.  Since the CI was placed on albuterol, dyspnea persisted with an average use of the albuterol two to three times per week in addition to before exercise.  Singulair (montelukast, an oral indirect-acting bronchodilator) was noted as a current medication on 17 February 2004.  On 9 March 2004 Advair (fluticasone, an inhalational steroid, and salmeterol, an inhaled bronchodilator) was added to the treatment protocol because of frequent use of albuterol, and the Singulair was to be discontinued after 2 weeks.  A note dated 6 May 2004 indicated the CI had been on Advair for 6 weeks and was doing well with running.  

The 31 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of dyspnea.  Physical examination showed a well-developed, well-nourished individual in no acute distress.  His nose was clear and he had faint expiratory rhonchi (gurgling or rattle-like sounds) especially at the right base.  Excursion (chest/respiratory) was normal without a prolonged expiratory phase.  

At the 18 October 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported a history of asthma that began following a course of bronchitis that went into pneumonia in 1998 to 1999.  He took Advair since March 2004 with good relief and decreased wheezing.  Physical examination showed equal expansion of the chest, which was clear to auscultation and percussion.  Pulmonary function tests revealed FEV1 84% predicted and FEV1/FVC 94%.

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 3 months after separation, citing assignment for inhalational anti-inflammatory medication.  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, and no higher, is warranted in the absence of diminished PFTs (FEV-1 less of 40-55% predicted or FEV-1/FVC of 40-55%), monthly visits to a physician for required care of exacerbations, or intermittent courses of systemic corticosteroids.  
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.  

Contended Conditions:  Overweight and Tobacco Use.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions (that are not separately unfitting and not compensable or ratable) were not unfitting.  Neither of the conditions was profiled, implicated in the commander’s statement nor judged to fail retention standards.  Overweight and tobacco use are not considered physical disabilities.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions; and so, no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602IAW VASRD §4.97.  In the matter of the contended overweight and tobacco use conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20160920, 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-2016-00858.

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