RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01690
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20041122

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

CI CONTENTION:  “Review all conditions.”  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 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 that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040825	VARD - 20050504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050128	
Tobacco Abuse	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first developed intermittent respiratory symptoms in 2003 while deployed to Iraq, and a formal diagnosis of asthma was established in May 2004.  She was initially treated intermittently with albuterol (inhaled bronchodilator), and was transiently prescribed Singulair™ (oral indirect-acting bronchodilator).  The latter was replaced with a prescription for Advair™ (inhalational steroid anti-inflammatory with bronchodilator) 2 weeks later.  There were some subsequent STR entries that listed Advair as a prescribed medication, although none of them addressed frequency of use or compliance, and a dental note stated only “asthma inhaler.”  There was no pharmacy data to corroborate dispensing and refills.  There was a single course of oral prednisone (systemic corticosteroid) in evidence.  There were multiple pulmonary function test (PFT) results in evidence.  Measurements of FEV1 (all post-bronchodilator) ranged from 83% to 85% predicted, and FEV1/FVC ratios from 86% to 88%.  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%).  
 
A comprehensive pulmonary evaluation of 29 July 2007, 4 months prior to separation, appeared to have been substituted for the NARSUM in PEB proceedings.  This stated “…symptoms are nearly constant although are controlled by albuterol.  Using albuterol nearly on a daily basis.  Admits to using Advair only on an occasional basis….”  Conversely, under medications, the examiner listed Advair as “not using” and albuterol as “prn [as needed].”  It was also stated in the assessment that the CI had “been non-compliant with her inhaled steroid” and had not complied with smoking cessation.  The physical examination recorded clear lungs.  There was a follow-up entry by the same specialist a week later that duplicated the same evidence.

The 28 January 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, documented good asthma control “despite the fact that she is no longer using Advair or Singulair.”  Treatment was with albuterol only, and this was confined to pre-exercise use about four times a week.  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 a 10% rating are “FEV-1 of [71-80%] predicted, or; FEV-1/FVC of [71-80%], or; intermittent inhalational or oral bronchodilator therapy.”  Those for 30% are “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.” Under the PFT criteria, the evidence does not support the minimum 10% rating.  A 10% rating is supported by the intermittent bronchodilator criterion.  This was presumably the basis for the PEB’s rating determination, although a rationale was not cited.  The VA’s 10% rating, based on the C&P evidence, cited intermittent bronchodilator.  

The panel deliberated whether the 30% daily bronchodilator criterion was fairly conceded based on the NARSUM statement (and in the follow-up note) that the CI was using albuterol on a “near daily” basis at that time.  Members agreed, however, that the contradictory evidence from the NARSUM itself, and the clear evidence to the contrary from the C&P examination (a bit closer to separation), overcame reasonable doubt for conceding the daily criterion based on the single “near daily” statement in the NARSUM.  The panel also deliberated whether the 30% criterion for inhalational anti-inflammatory was fairly conceded based on the NARSUM statement (and in the follow-up note) that the CI was still using Advair on an “occasional” basis, given that §4.97 does not stipulate that this criterion requires daily use.  Members agreed, however, based on the same contrary evidence and rationale just elaborated for the daily bronchodilator criterion, that the inhalational anti-inflammatory criterion was also not reasonably conceded.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.

Contended PEB Condition:  Tobacco Abuse.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended tobacco abuse condition, the panel unanimously recommends no change from the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161103, w/attachments
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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01690.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings