RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01499
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040517

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

CI CONTENTION:  Review ratings for asthma and irritable bowel syndrome.  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 - 20040324	VARD - 20041202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Mild Intermittent Asthma	6602	10%	20040917	
Irritable Bowel Syndrome	Cat II	Irritable Bowel Syndrome	7319	10%	20040917	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Asthma.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first diagnosed with asthma in December 2001.  An STR entry from that period documented treatment with Flovent (an inhalational steroid anti-inflammatory) and albuterol (inhaled bronchodilator).  Subsequent entries reflected a period of time when the CI was treated only with albuterol as needed, but her symptoms rebounded and an entry in November 2003 (6 months before separation) documented that Flovent was re-prescribed.  Multiple entries after that confirmed that Flovent was refilled and remained in use.  There were multiple pulmonary function test (PFT) results in evidence.  Measurements of FEV1 (some post-bronchodilator, some not) ranged from 81% to 95% predicted, and FEV1/FVC ratios from 83% to 96%.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  

The 14 January 2004 NARSUM examination, 4 months prior to separation, documented a complaint of “wheezing when exercising.”  It confirmed a diagnosis of asthma by methacholine challenge, and noted the failed trial of treatment without inhalational steroid followed by the need to restart Flovent.  The NARSUM listed Flovent (daily dosing) along with albuterol (as needed) in current medications, and cited the most recent of the above PFT measurements (FEV1 95% and FEV1/FVC 83%).  The physical examination recorded clear lungs.  

The 17 September 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, documented intermittent asthma flares associated with “excess exercise or walking.”  It noted that the CI had been prescribed Flovent and albuterol, although it did not comment on current use or compliance, and it did not provide an active medication list.  The physical examination recorded clear lungs.  

The panel directed attention to its rating recommendation based on the above evidence.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under code 6602 (asthma).  The 6602 criteria for a rating higher than 30% were not in evidence (as above).  The criteria for the ratings under consideration are: 30% - “FEV-1 of [56-70%] predicted, or; FEV-1/FVC of [56-70%], or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication;” and, 10% - “FEV-1 of [71-80%] predicted, or; FEV-1/FVC of [71-80%], or; intermittent inhalational or oral bronchodilator therapy.”  

A 10% rating is supported by the intermittent bronchodilator criterion in this case.  This was presumably the basis of the PEB’s rating determination, although a rationale was not cited.  The VA rating decision acknowledged the use of Flovent from the C&P evidence and cited “inhalational anti-inflammatory medication” as a 30% criterion; but, somewhat confusingly, conferred a 10% rating.  There was very convincing evidence in the service file that Flovent was in regular use at separation; and, members agreed that the 30% inhalational anti-inflammatory criterion was well supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 30% rating for the asthma condition under code 6602.

Contended PEB Condition:  Irritable Bowel Syndrome (IBS).  There were STR entries that documented an onset of abdominal pain (right upper quadrant) in 2001.  The CI underwent a laparoscopic cholecystectomy in July 2001.  The symptoms persisted, further evaluation was negative, and the empirical diagnosis was IBS.  The STR clinical notes portrayed intermittent pain, rare nausea and vomiting, and no diarrhea.  There was only one STR entry for symptomatic treatment in the 12 month period preceding separation.  The MEB was directed at asthma only, and IBS was not forwarded on the AF Form 618 MEB submission; although, it was adjudicated by the PEB as Category II (conditions that can be unfitting but are not currently compensable or ratable).  The NARSUM noted IBS in the medical history, but did not elaborate or document any active symptoms.  

The panel directed attention to its recommendation based on the above evidence, and its main charge was an assessment of the fairness of the PEB’s determination that IBS was not unfitting.  Members agreed that there was no performance-based evidence to indicate that the condition interfered with duty requirements to an extent that would have prohibited further military service.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of irritable bowel syndrome, thus it was not eligible for disability rating.
BOARD FINDINGS:  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended irritable bowel syndrome, the panel unanimously recommends no change from the PEB adjudication as Category II and not subject to rating.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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 her prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161003, 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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01499.

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.

Attachment:
Record of Proceedings