RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00974
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20041012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Controls & Warning Systems 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 - 20040803	VARD - 20050511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050111	
Lymphedema of RLE	Cat II 	Stress-Induced Urticaria and Bilateral LE Lymphedema	7799-7118	40%	20050111 	
Tobacco Abuse	Cat III	No VA Placement	
Obesity	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in pulmonary medicine on 11 November 2003 for a several-year history of recurrent exertional shortness of breath (SOB), dyspnea, and chest discomfort when running.  A diagnosis of asthma was made based on clinical presentation and pulmonary function testing (PFT) which showed an FEV-1 of 85% predicted. Although the latter did not show an obstructive defect (as seen in asthma), reversibility with treatment was demonstrated.  The CI was prescribed Advair (inhalational steroid/bronchodilator combination) twice a day, albuterol (inhalational bronchodilator) as needed, and Singulair (oral indirect-acting bronchodilator).  She was thought to be overweight with an allergic component to the asthma; the CI reported an increase in symptoms since moving to Florida.  

The MEB NARSUM examination dated 19 April 2004, 6 months prior to separation, noted that the CI was taking albuterol as needed, Advair twice a day, and Singulair once a day.  She reported symptoms about 5 minutes into a run.  Her pulmonary examination was unremarkable.  

The 7 June 2004 PFT, 4 months prior to separation, showed an FEV-1 of 91% of predicted and an FEV-1/FVC of 85%.  Following the PEB, the CI was seen in primary care on 9 September 2004 requesting a medical hold due to her pregnancy (she was 16 weeks at that encounter).  She had stopped all asthma medications and denied pulmonary symptoms.  Her lungs were clear without signs of respiratory distress.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.  

At the 22 January 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the examiner noted the CI was not taking any medications due to her pregnancy (she preferred not to use them).  She reported that she had moved from Florida to Virginia and her symptoms were much improved.  She only had mild symptoms if she did a lot of walking; these resolved if she stopped and rested.  The examination showed that the 64-inch CI weighed 204 pounds.  The examiner did not comment on the etiology of her symptoms.  PFTs showed an FEV-1 of 88% of predicted and an FEV-1/FVC of 97%, which the examiner noted was normal as was the pulmonary examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, with likely application of the DoDI 1332.39 rating guidance in effect at the time, which differed from VASRD rating criteria.  The VA rated the asthma condition 10%, coded 6602, citing that although the CI was “not taking asthma medications due to [her] pregnancy at the time of VA examination, a history of intermittent inhalational bronchodilator therapy [had] been established” and “a higher evaluation at [the] time [could not be granted] because [her] current symptomatology [did] not approximate the criteria for a rating in excess of 10 percent.”  

Panel members agreed the VA C&P examination, which was more complete and more proximate to separation, held more probative value than the service examinations.  There was no PFT evidence (i.e. FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent) to support the next higher 30% rating.  The VA examination was also consistent with the final clinical note in the record, which was one month prior to separation.  Likewise, a 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  Therefore, the panel agreed the evidence of the record did not support a rating higher than that adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

Contended PEB Condition:  Lymphedema of Right Lower Extremity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was Category II not unfitting.  The contended condition was not profiled or judged to fail retention standards, but it was implicated in the commander’s statement.  However the commander’s statement indicated, “her condition does not appear to hamper her ability to satisfactorily perform her current duties or her primary AFSC duties” (in garrison).  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 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.  

Contended PEB Conditions:  Tobacco Abuse and Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were Category III, not separately unfitting and not compensable or ratable.  These conditions do not constitute physical disabilities IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending them as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for these contended conditions and so no additional disability rating is recommended. 

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.100, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended lymphedema of the right lower extremity, the panel unanimously recommends no change in the PEB adjudication as a Category II not unfitting.  In the matter of the contended tobacco abuse and obesity conditions, the panel unanimously recommends no change from the PEB determinations as Category III.  There are no other conditions within the panel’s scope of review for consideration.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160922, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00974.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings