RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01326
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Radio Communications Systems Journeyman, medically separated for “asthma” with a disability rating of 10%.   

CI CONTENTION:  “My VA disability for asthma is 30%.”  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 progression or complications of service-connected conditions after separation.  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031117	VARD - 20040514	
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 Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s asthma condition began in January 2003 with complaints of difficulty breathing.  Radiographic studies were normal.  The pulmonary function test (PFT) performed in July 2003 showed an FEV-1 of 92% of predicted and an FEV-1/FVC of 91% with minimal airflow obstruction and significant response to bronchodilator.  According to the initial pulmonary clinic evaluation on 2 July 2003, the CI reported daytime wheezing, shortness of breath and a cough two times per week or less.  She also reported her physical activities were limited by asthma more than twice a week and used albuterol (inhalational bronchodilator) intermittently.  She had one emergency room visit in the last year (February 2003).  The examiner noted the CI was on albuterol twice a week and reported she last used it the prior week.  The examiner prescribed Proventil (inhalational bronchodilator), two puffs 30 minutes prior to exercise and every 4-6 hours as needed and Advair (inhalational steroid/bronchodilator combination) twice daily.     

At the 21 August 2003 family practice clinic appointment, the CI reported she used Albuterol before she went to the gym and twice a month as a “rescue drug.”  The examiner noted the CI used Advair; however, there was no indication of the dosage or the frequency.  A diagnosis of mild persistent asthma was given.  The PFT dated 18 September 2003, 5 months prior to separation, showed an FEV-1 of 64% of predicted and an FEV-1/FVC of 93%, with minimal airflow obstruction and a significant response to bronchodilator, but the 29 September 2003 PFT showed an FEV-1 of 71% of predicted and an FEV-1/FVC of 91%, with moderate airflow obstruction.  The 19 October 2003 MEB NARSUM examination, 4 months prior to separation, noted the CI was taking Advair and Albuterol (as needed).  Chest examination showed equal expansion, clear to auscultation bilaterally, no wheezing, rales, rhonchi and fair air exchange.  

At the 20 May 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the examiner noted the CI was taking albuterol, as needed, with no indication of frequency; however, the CI reported she had approximately one episode of asthma per week.  Physical examination of the chest showed the “lungs were clear to auscultation, no tightness whatsoever with good airflow in all major lung groups, no wheezing.”  The examiner opined the asthma was under good control and did not feel the asthma was related to her military duty.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing DoD and VASRD guidelines.  The VA rated the asthma condition 30%, coded 6602, citing the requirement and daily use of an inhaler.   A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy and a 30% rating stipulates daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.”  Panel members noted the family practice and MEB NARSUM examinations reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed, as noted by the MEB NARSUM examiner.  Panel members agreed 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.  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 §4.97.  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, 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-2016-01326.

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.