RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00934
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Protection Journeyman, 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 - 20040412	VARD - 20050128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20041201	
Seasonal Allergic Rhinitis	Not unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially presented with symptoms of wheezing in April 2003.  A diagnosis of mild asthma was made based on pulmonary function testing (PFT) and clinical presentation.  On 13 August 2003, 12 months before separation, PFTs showed an FEV-1 of 78% of predicted and an FEV-1/FVC of 61%.  On 22 September 2003, PFTs showed an FEV-1 of 88% of predicted and an FEV-1/FVC of 67%; and 4 November 2003, PFTs showed FEV-1 of 79% and FEV-1/FVC of 67%.  

During the 15 December 2003 MEB NARSUM examination, 8 months prior to separation, the CI reported taking albuterol as needed for bronchospasm.  At the 18 March 2004 family practice appointment, 5 months before separation, the only listed asthma medication was albuterol, with a note that “states he never uses it.”  In an undated memorandum that was included with his MEB, the CI reported that “I only use the inhaler when I start to wheeze, which is only every once in a while.”  On 22 April 2004, 4 months before separation, PFTs showed an FEV-1 of 85% of predicted and an FEV-1/FVC of 65%.  

At the 19 July 2004 family practice visit, 1 month prior to separation, the CI reported he was taking albuterol.  The clinician added a prescription of Advair (inhaled anti-inflammatory medication).  On the 27 July 2004 Report of Medical Assessment (DD Form 2697), the CI reported taking Advair for his asthma, and also listed Advair on a Dental Patient Medical History form (AF Form 696) the following day.  

At the 1 December 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported that symptoms had almost completely resolved since his separation and move to Phoenix, Arizona, and that he no longer had to use his inhalers.  There was no report PFTs or medication use.  

The panel directed attention to its rating recommendation based on the above evidence.  The formal PEB rated the asthma condition 10%, coded 6602 (asthma), citing testimony that the CI had been asymptomatic for several months and had not used albuterol since his initial diagnosis.  The VA rated the asthma condition 0%, also coded 6602, based on the C&P examination 3 months after separation, citing only the FEV1 evidence from the PFTs, and not the FEV1/FVC values.  

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 all four PFTs in the record proximate to separation showed an FEV-1/FVC between 61% and 67%, and agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case based on these consistent measurements.  Members also noted that the CI was prescribed and used Advair, an inhalational anti-inflammatory medication, during the period immediately before and after separation.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  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 PEB Condition:  Seasonal Allergic Rhinitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended seasonal allergic rhinitis condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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, 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%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

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Dear Applicant:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00934.

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 (210) 565-2273 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.