RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00752
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070122

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

CI CONTENTION:  “Having heavy asthma problems.  Having trouble breathing during heavy activity even with inhalers.”  The CI also requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20061208	VARD - 20070802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20070522	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI complained of cough, dyspnea, and wheezing on exertion.  Albuterol (an inhalational bronchodilator) did not provide relief.   The CI had pulmonary function testing (PFT) that showed a mild restrictive ventilatory defect based on a mildly reduced forced vital capacity (FVC) on 14 July 2005.  Cetirizine (an antihistamine), montelukast (oral indirect-acting bronchodilator), and Proventil (albuterol, an inhalational bronchodilator) were prescribed.  A chest X-ray dated 2 August 2005 showed a patchy multifocal consolidation, which was suspicious for pneumonia.  On 8 August 2005 a methacholine test was positive, which confirmed the diagnosis of asthma.  Treatment on 15 August 2005 consisted of azithromycin (an antibiotic), albuterol, and Advair (an inhalation steroid/bronchodilator combination), and the CI was advised to quit smoking.  On 21 September 2005 he reported no symptoms since using the medications.  A same-day chest X-ray was normal.  Allergy testing on 14 December 2005 was positive for dust mites and grass.  Additionally, the CI was noted to have a deviated septum.  The examiner emphasized dust mite avoidance and stressed the CI take Advair on a regular basis.  Rhinocort (budesonide, a steroid) spray and Zyrtec (cetirizine) were prescribed. 

The 23 June 2006 MEB NARSUM examination, 7 months prior to separation, noted the CI was doing well and had no urgent visits to the clinic or emergency department.  Current medications were Advair twice a day, an albuterol inhaler as needed, Rhinocort, and Zyrtec.  Physical examination showed his lungs were clear to auscultation with good air movement.  The examiner stated the CI had mild persistent asthma that was well controlled.  On 2 August 2006, 5 months prior to separation, PFT showed an FEV-1 of 77% of predicted and an FEV-1/FVC of 89%. The 10 October 2006 NARSUM addendum, 3 months prior to separation, noted the CI reported using albuterol only once per week, but had symptoms of shortness of breath when he exercised outdoors.  The examiner noted that at a 21 September 2006 re-evaluation, the CI reported he stopped using the Advair, was exercising on a bike and experienced some chest pressure, but his condition was not limiting his activity.  Spirometry was reported as an FEV-1 of 87% of predicted and then was reported as pre-nebulizer 79% of predicted and post-nebulizer 81% of predicted.  On 11 October 2006 the findings were interpreted as a mild restrictive ventilatory defect by the finding of a mildly reduced forced vital capacity of 74% of predicted.  

At the 22 May 2007 VA Compensation and Pension (C&P) general medical examination, 4 months after separation, the CI reported occasional flare-ups about once a month, which were associated with cold or exertion.  Otherwise, he only had a frequent cough for which he used albuterol once or twice a day as needed and had not used any other medication for the asthma.  The 18 June 2007 C&P respiratory examination was completed by the same examiner who noted the CI was treated with hand-held bronchodilator medications as needed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both rated the asthma condition 10%, coded 6602 (asthma, bronchial).   The VA rating was based on the C&P examination, citing FEV-1 of 71 to 80 percent of predicted value; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalation or oral bronchodilator therapy.   

Panel members agreed that a 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the NARSUM and C&P examinations.  There was no satisfactory evidence of daily inhalational or oral bronchodilator therapy or of inhalational anti-inflammatory medication use to justify the next higher 30% rating nor was there any PFT evidence to support the next higher 30% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the panel recommends no change in 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.    

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00752.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.