RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01401
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Personnel Journeyman, medically separated for “asthma” with a disability rating of 10%.

CI CONTENTION:  In addition to her asthma, the CI contends her migraines, sinusitis and right shoulder conditions should have been rated.  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 - 20040803	VARD - 20041123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20040713	
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 was evaluated in January 2004 for a recent history of exertional shortness of breath.  Recurrent shortness of breath led to evaluation for possible asthma.  Although initial pulmonary function testing (PFT) was normal in March 2004, provocation testing (histamine challenge) in April 2004 was positive, consistent with the diagnosis of asthma.  

The 2 April 2004 MEB NARSUM examination, 7 months prior to separation, noted the CI was taking Albuterol (inhalational bronchodilator) as needed for about 1 month, used before exertion, not used for symptom relief.  The examiner recorded the CI had asthma symptoms of shortness of breath, wheezing and a dry cough which occurred twice a week and the use of an Albuterol inhaler in the past, did not help alleviated the symptoms.  Examination of the lungs showed normal respiratory effort without accessory muscle use, clear with good air movement to auscultation bilaterally.  The examiner reported “I feel she likely has persistent asthma, which may be complicated by GERD and/or sinus disease.  She seems to have done better since these confounders were treated.  I will give her a trial of Advair therapy (inhalational anti-inflammatory medication) and send [to the] MEB.  Patient should have a good prognosis once asthma has been treated, and should continue to be able to perform her USAF duties.”  

At the time of the 25 June 2004 Asthma and Allergy Institute appointment, 4 months prior to separation, the examiner reported symptoms consistent with allergic rhinitis as well as symptoms of cough and shortness of breath may be due to asthma.  The CI described the symptoms as cough with running and working out, as well as shortness of breath and chest tightness occasionally.  She had a nighttime cough one to two times a week.  She reported she “was placed on Advair and had done okay but she does not take the Advair on a regular basis.”  The examiner recommended a methacholine challenge to make a more definitive diagnosis.  Chest examination showed normal breath sounds without wheeze, rhonchi or rales.  The examiner reported a normal PFT with an FEV1 of 106% and a FEV1/FVC of 101%.  Diagnoses of allergic rhinitis by history and persistent exercise-induced cough and shortness of breath were given.  At the 6 July 2004 follow-up Asthma and Allergy Institute appointment, 2 weeks later, the examiner reported a methacholine challenge was positive which would be consistent with asthma and recommended preventive treatment with Advair and Singulair (oral indirect-acting bronchodilator).  The examiner also reported the CI had allergic rhinitis based on her skin testing which was positive for grass, weeds, trees, cats and dogs.  The examiner did not diagnose the CI with asthma; however, did recommend a treatment plan of Advair, one puff two times a day; Singular, daily, Albuterol, two puffs every 4 hours as needed, and allergy shots.   

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 13 July 2004 VA Compensation and Pension (C&P) evaluation, 4 months prior to separation, the CI characterized her symptoms as wheezing, tightness of the chest and dyspnea.  The examiner noted the CI was currently on Advair and Allegra-D with ongoing symptom mitigation and she never required intubation, emergency room visits or hospitalizations.  At the 8 September 2004 C&P evaluation, 2 months prior to separation, for evaluation for allergy, sinus, and gastroesophageal reflux disease; allergy testing revealed the CI had multiple allergies to most Arizona trees, grasses and weeds; dogs and cats.  The examiner evaluated the CI for asthma and indicated the CI had been placed on Advair, Albuterol, and Singular, but she was currently only on Advair and Allegra-D (an antihistamine and a decongestant).  The examiner noted “there seems to be a component of reflux which makes the patient’s asthma worse.”  PFT test conducted on 29 September 2004 showed a FEV1 of 101% and a FEV1/FVC of 86%, all normal measurements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602, citing provider noted the member seemed to have done better since her confounders (sinus and GERD) were treated.  The PEB opined the CI condition was being treated with the standard level of care for her diagnosis and, based on her level of functionality, was appropriately rated.  The VA rated the asthma condition 10%, coded 6602, citing intermittent inhalational and oral bronchodilator therapy and a normal PFT 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 record consistently documented use of Advair beginning prior to the Asthma & Allergy clinic visit 4 months pre-separation and continuing through, and validated by, the two pre-separation VA examinations.  Although early notes indicated the CI did not consistently take her Advair, later evaluations did not mention non-compliance.  For rating under code 6602 (asthma), the 30% criteria does not require daily use of inhaled anti-inflammatories, and the rating criteria is met with use of inhaled anti-inflammatories at least intermittently.  Panel members agreed the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication use (Advair).  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, 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, received 20161014, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01401.

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 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,

Attachment:
Record of Proceedings