RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00918
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041217

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

CI CONTENTION:  “No retirement was given.”  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 - 20041005	VARD - 20041222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma symptoms began in July 2003 after developing shortness of breath (SOB) with activity and exposure to cigarette smoke.  She presented to the emergency room in September 2003 due to SOB.  Medication for asthma was prescribed (Albuterol and Prednisone) which reportedly provided significant improvement.  In October 2003 Advair (inhalational steroid/bronchodilator combination) was initiated. 

Initial pulmonary function testing (PFT) in November 2003 showed an FEV-1 of 59% of predicted and an FEV-1/FVC of 73 percent.  The 28 January 2004 pulmonary consultation noted the CI was taking Advair daily and Albuterol (inhalational bronchodilator) prn (as needed).  Lungs revealed bilateral expiratory wheezes.  The examiner noted suboptimal control with exercise induced bronchospasm and felt there may have been some component of esophageal reflux contributing to her symptom complex.  Advair dosage was increased and Singulair (oral indirect acting bronchodilator) was added.  The examiner noted follow-up in 2 months to document improvement with PFTs.  Her profile allowed her to exercise at her own pace.  The May 2004 Commander’s statement noted the CI‘s condition did not affect her performance since her diagnosis in February; the medications suppressed her symptoms.  The June 2004 PEB memo noted only 2 abnormal tests and requested two more PFT’s at least 1 day apart, noting the tests should agree within 5 percent of each other.  A consult for a methacholine challenge test in August 2004 was reported as negative.  On 1 October 2004 a spirometry report provided no formal interpretation but baseline FEV1 was 123% of predicted.  

The MEB NARSUM examination noted complaints of SOB with significant improvement once medication was initiated.  Exercising outside was more difficult than if she was inside.  Medications listed were Singulair 10 mg and Advair daily.  Physical examination showed lungs were clear to auscultation bilaterally.  A diagnosis of moderate persistent asthma was rendered.  The examiner noted the CI was doing well on her current medication regimen.  PFT findings from November 2003 were noted to demonstrate a restrictive defect.  There was no VA examination in evidence 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 (asthma, bronchial), citing normal methacholine challenge test.  The VA rated the asthma condition 30%, coded 6602, (asthma, bronchial), based on the STR, citing FEV-1 of 59 percent and daily use of bronchodilators.  The PEB noted the CI’s symptoms were indicative of asthma despite normal methacholine challenge test.  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 that the examinations in evidence reported current prescription and daily use of bronchodilators.  Inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% requirement, were also prescribed, as noted by the NARSUM examiner.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and 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 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 unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.100.  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 20161229, 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-2016-00918.

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.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the 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