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-2016-01733.

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.

						Sincerely,

		

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2016-01733
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Language Analyst, medically separated for “asthma” with a disability rating of 10%. 

CI CONTENTION:  The CI requested an accurate and fair review of her condition.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20020315	VARD - 20021017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Bronchial Asthma	6602	30%	20020812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in basic training in February/March 2001 after a series of frequent sinus and upper respiratory infections, which were treated.  In August 2001 she received Decadron (dexamethasone, a steroid) for sinusitis and noticed that her breathing was better for approximately 1 day thereafter.  Additionally, she underwent an adenoidectomy on 22 August 2001.  X-rays dated 17 September 2001, ordered for rales and wheezing, showed mild bilateral parahilar bronchial wall thickening without any focal infiltrates compatible with bronchiolitis.  The CI had bronchitis diagnosed on 17 September 2001, which was treated with cough medication, prednisone, and antibiotics.  On 1 October 2001 the CI reported problems with shortness of breath/wheezing with exertion for 9 months.  The examiner’s assessment was rule out asthma versus bronchiectasis.   Albuterol (an inhaled bronchodilator) was prescribed.  Pulmonary function tests (PFTs) on 3 October 2001 revealed an FEV1 of 83% predicted and FEV1/FVC of 85%.  On 16 October 2001 the pre-bronchodilator FEV1 was 67% predicted and post-bronchodilator was 78% predicted while the FEV1/FVC was 69% pre-bronchodilator and 79% post-bronchodilator.  The diagnosis of mild to almost moderate asthma was made with an obstructive ventilatory abnormality that nearly normalized with a significant bronchodilator response in the lab.  On the same day the pulmonologist reviewed all of the CI’s antecedent respiratory history and prescribed Flovent (an inhalational steroid) and Proventil (albuterol) as needed. On 9 October 2001 she had poison oak dermatitis and was given a tapering dose of prednisone, which resulted in breathing even better than it had been before.  During a phone conversation with her pulmonologist on 24 October 2001, the CI reported exacerbation of the asthma with cold and damp air.  Prednisone use was discussed; Flovent dose was to be increased; and Serevent (salmeterol, an inhalational bronchodilator) was to be started.  A note dated 9 November 2001 indicated the CI was doing well with prednisone, but was concerned about stopping it.  A tapering schedule was developed and Singulair (montelukast, an indirect bronchodilator) was to be instituted.  

The CI’s asthma was exacerbated by an upper respiratory infection.  On 16 January 2002, an antibiotic was prescribed and the prednisone dose was increased with a taper plan over time.  A note dated 28 January 2002 indicated the CI had a flare of symptoms the prior evening with shortness of breath, wheezing, and cough.  Repeat PFTs on 29 January 2002 were FEV1 68% predicted and FEV1/FVC 82%, while on 30 January 2002 FEV1 was 61% predicted and FEV1/FVC was 73%.  On 31 January 2002 FEV1 was 72% predicted pre-bronchodilator and 98% post-bronchodilator and FEV1/FVC was 80% pre-bronchodilator and 86% post-bronchodilator.  On 5 February 2002 the CI reported shortness of breath and wheezing while running.  After rest the asthma symptoms were better, and she felt back to her baseline. On 19 February 2002, prednisone was listed as a current medication. 

The 7 January 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of shortness of breath and wheezing.  Physical examination showed the CI had a normal respiratory rate and was afebrile.  Pulse oximetry on room air was 98%.  Her lungs were clear even on a forced vital capacity maneuver although the CI had taken albuterol earlier.  Cardiac examination was without murmurs or rubs and there was no clubbing or edema of the extremities.  The examiner indicated the results of the PFTs dated 16 October 2001 (see above) were consistent with an obstructive ventilatory abnormality, and “prednisone may be required intermittently while she remains in this environmental condition” marked by cold and dampness exposure. PFTs dated 31 July 2002, almost 3 months after separation, revealed a pre-bronchodilator (Combivent (ipratropium/albuterol)) FEV1 of 68% predicted and a post-bronchodilator of 101% and FEV1/FVC of 78% and post bronchodilator 86%.  

At the 12 August 2002 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported episodic problems with shortness of breath when there was a change of weather.  She used her rescue inhaler (albuterol) approximately one time per month, which seemed to alleviate her shortness of breath on most occasions.  This was in addition to her chronic daily medications (Flovent, Serevent, Singulair and intermittent prednisone dose packs).  Physical examination showed clear breath sounds without wheezes, rales, or rhonchi.  There was no presence of cor-pulmonale, right ventricular hypertrophy, or pulmonary hypertension.  The examiner indicated that based on the PFTs of 31 July 2002 the CI would benefit from bronchodilator therapy and the assessment of the CI’s condition was bronchial asthma.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma, bronchial).  The VA rated the asthma 30%, coded 6602, based on the C&P examination, citing medication requirements for control of bronchial asthma. 

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 examinations in evidence reported current prescription and use of daily bronchodilators and inhaled anti-inflammatories.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of inhalational anti-inflammatory medication use.  The panel then discussed 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.”  The CI’s use of prednisone was reviewed in depth; however, the panel majority felt that the documented use of prednisone was insufficient to warrant a 60% rating and felt that a 30% rating represented the CI’s overall disability.  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 majority recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  The single voter for dissent submitted the appended minority opinion.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161106, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record