RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01219
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040802

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

CI CONTENTION:  She is still having problems with her back and asthma conditions and should be rated 70%.  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 MEB, but determined by the PEB 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 - 20040517	VARD - 20041215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease	6602-6699	10%	Asthma	6602	30%	20041022	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Reactive Airway Disease.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in childhood but was quiescent until December 1999 when she was seen for a viral illness accompanied by fever, cough and wheezing.  Breathing treatments, an oral corticosteroid and inhaled bronchodilator resolved her symptoms.  In November 2000 she was referred to the allergy clinic when she again had a cold with coughing and wheezing.  In January 2001, a prescription for a daily-use, inhaled anti-inflammatory medication from the allergy specialist was refilled (original prescription not available).  Based on the STR, every medical visit after that included inhaled anti-inflammatory medication in the current prescription list and noted “reactive airway disease,” a broad category of pulmonary diseases that includes asthma, as an active medical problem.  
On 26 March 2004, pulmonary function tests (PFTs), while the CI was on an inhaled anti-inflammatory, showed an FEV-1 of 109% of predicted and an FEV-1/FVC of 89% after administration of an inhaled bronchodilator.  During the 29 March 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported taking the inhaled anti-inflammatory twice a day, and an inhaled bronchodilator every evening.  

At the 22 October 2004 VA Compensation and Pension (C&P) evaluation, 3 months after  separation, the CI reported flare-ups or asthma attacks about every other month, sometimes with exercise, but usually related to allergies.  She was using an inhaled anti-inflammatory every day and an inhaled bronchodilator prior to workouts.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the reactive airway disease condition 10%, coded analogously coded 6602-6699 asthma, bronchial).  The VA rated the asthma condition 30%, coded 6602, citing Flovent (anti-inflammatory) inhaler use every day, with Albuterol (bronchodilator) prior to workouts.  Panel members noted that inhaled anti-inflammatories were required and used, as recorded by the MEB and VA examiners.  The majority of 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/or inhalational anti-inflammatory medication use.  Review of the STR found no clinical encounters in evidence documenting oral or parenteral (injection) steroid use during the year prior to separation or that exacerbations were frequent enough to require monthly visits to a physician to meet criteria for the next higher 60% rating.  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.  

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 submitted the appended 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, 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 20160930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MINORITY OPINION:  

The minority dissent with the majority recommendation is based on the totality of the evidence from the STR.  Based on a preponderance of this evidence, the minority member opines that the PEB correctly rated the “reactive airway disease” at 10%.

There was no evidence that the CI was diagnosed with asthma; however, the CI was diagnosed and treated for allergic rhinitis.  There were no pulmonary function testing (PFTs) prior to separation that met the minimum criterion for a 10% rating.  A PFT on 26 March 2004, 3 days prior to the MEB NARSUM, showed an FEV-1 of 109% of predicted and an FEV-1/FVC of 111% after administration of an inhaled bronchodilator, which doesn’t meet the minimum criterion for a 10% rating.  

The MEB NARSUM reported that the CI used Flovent daily, which was prescribed to treat allergies and a rescue inhaler was only used approximately once every 3 months.  The CI did not miss any duty days due to her condition of reactive airway disease.  

The minority member opines that the PEB correctly rated “reactive airway disease” at 10% based on the intermittent use of inhalational bronchodilator therapy as a rescue inhaler.  Consistent with the DoDI 6040.44 standard of recommendations that are fair and equitable to both the Service and the CI, the Secretary is respectfully requested to consider the minority recommendation that there be no re-characterization of the CI’s service disability determination. 

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-2016-01219.

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 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