RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01472
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20041227

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

CI CONTENTION:  “Please consider all records.”  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 - 20040805	VARD - 20050930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050818	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record, the CI’s asthma condition was first treated in 2001 after she experienced allergies, chest tightness, and shortness of breath.  In April 2002 she was seen in the Emergency Room (ER) for severe asthma.  She had chronic sinusitis as well as nasal polyposis confirmed by computerized tomography (CT), and underwent bilateral ethmoid and maxillary sinus endoscopic surgery.  The CI did better after sinus surgery and was treated with Advair (an inhaled steroid/bronchodilator), Accolate (zafirkulast, a leukotriene inhibitor to prevent asthma), and albuterol (an inhaled bronchodilator).  She had several exacerbations of asthma requiring oral or parental steroids from late 2002 through 2003 and was admitted to the hospital for an asthma exacerbation on 18 November 2003.  She was treated with Solu-medrol (a steroid), prednisone, Serevent (an inhaled bronchodilator), and albuterol and was discharged on prednisone and her regular asthma medications.  She was taking prednisone for upper respiratory symptoms despite using inhalers.  A chest X-ray in February 2004 was normal.  The CI was admitted to the hospital on 2 March 2004 and was treated with intravenous steroids and on discharge resumed outpatient prednisone and her other listed medications  A note dated 30 March 2004 indicated the CI had been weaned off prednisone 2 weeks earlier and used albuterol multiple times a day.  Advair and Xolair were resumed.  Prednisone was started again on 20 April 2004 for bilateral edema of the sinonasal cavities.  A pulmonary note dated 28 April 2004 indicated the CI had recurrent exacerbations and had been hospitalized twice in the previous 6 months.  She needed oral steroids and was started on a new IgE antibody inhibitor (Xolair).  Pulmonary function tests (PFTs) on 3 May 2004 revealed FEV1 pre-bronchodilator of 73% of predicted and FEV1/FVC of 73%, and post-bronchodilator FEV1 79% and FEV1/FVC 76%.  CT of the paranasal sinuses dated 9 June 2004 demonstrated pan-sinus mucosal thickening with evidence of extensive surgery and the bilateral frontal sinus was completely opacified.  On 15 June 2004 the CI reported decreased symptoms since starting Xolair with albuterol rescue.  

The 17 August 2004 Medical Evaluation Board (MEB) narrative summary (NARSUM), 4 months prior to separation, noted the CI had two asthma hospitalizations within the prior 6 months, had recurrent bursts of steroids in the prior year, and had approximately eight acute visits for shortness of breath.  Physical examination of the lungs revealed opening pops and diffuse mild expiratory wheezes bilaterally.  On 23 November 2004, 1 month prior to separation, the CI’s medications included Xolair monthly, albuterol five times in 6 months, Accolate twice a day, and Advair twice a day for asthma  

At the 18 August 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported dyspnea on exertion (shortness of breath) and cough related to her asthma.  Her medications included zafirlukast daily and cetirizine (an antihistamine) daily.   Physical examination revealed no evidence of sinus infection and her lungs were clear to auscultation.  PFTs revealed FEV1 pre-bronchodilator 85% of predicted and 91% of predicted post-bronchodilator, and FEV1/FVC 72% pre-bronchodilator and 74% post-bronchodilator.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing severe, persistent asthma.  The VA also rated the asthma condition 10%, citing pulmonary function measurement FEV-1 of 71 to 80%.  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.”  The panel agreed a 30% rating was justified by the CI’s prescribed use of inhalational anti-inflammatory medications (Advair and Xolair) at the time of separation.  A 60% rating, which requires: “FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids,” was considered.  Although there was no evidence of monthly visits for care of exacerbations, it was agreed there was satisfactory evidence that systemic steroids were given sufficiently (“systemic steroid use three times per year”) to satisfy this requirement; therefore the next higher 60% rating was justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 60% for the asthma condition, coded 6602.

BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 60%, 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 the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	60%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160920, w/atchs
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-2016-01472.

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