RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00900
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20070525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “mild persistent 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 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 FPEB - 20070305	VARD - 20081120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Persistent Asthma	6602	10%	Asthma	6602	30%	20080518	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Mild Persistent Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma condition began in January 2006 following a 9-month history of “chronic bronchitis.”  Treatment included Albuterol inhalers and short oral steroid bursts.  In March 2006, the CI related numerous nocturnal awakenings from coughing and wheezing that improved with Albuterol use.  A pulmonary function test (PFT) completed on 22 March 2006 showed FEV 1 at 88.2% and FEV1/FVC at 92.5%.  A pulmonologist determined the CI had a mild airflow obstruction with significant response to bronchodilator, normal lung volumes, and elevated residual volume with lung trapping consistent with asthma.  

The 20 November 2006 MEB NARSUM examination, 6 months prior to separation, noted the CI was placed on an Advair inhaler, which reduced the Albuterol use and improved the CI’s symptoms.  Physical examination showed diffuse wheezing and normal respiratory rhythm, depth, and movement.  Medications included Xopenex inhaler, Advair 250/50 inhaler (inhalational anti-inflammatory), and Flovent (inhalational anti-inflammatory) as needed.  At the 18 May 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported that, while in Germany, there were “some kind of triggers” in the air.  Dust, cold, and extended exercise all triggered the symptoms.  Medication included Xopenex inhaler (inhalational bronchodilator) as needed and Flovent twice daily.  Since moving to Cheyenne a month previously he had only had to use his Xopenex once.  Physical examination showed the lungs were clear to auscultation with normal breathing; however, end expiratory wheezing was present with forced expiratory effort.  Chest X-ray on 16 May 2008 was read as normal.  A PFT revealed FEV1 at 89.3% and FEV/FVC at 81.8%

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing Flovent was required daily.  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 MEB NARSUM and VA C&P examinations reported current prescription and use of daily bronchodilators.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of anti-inflammatory medication use.  A 60% rating was not justified in the absence of at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic corticosteroids.  There was no PFT evidence to support the next higher 60% rating.  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 recommends a disability rating of 30%, coded 6602 IAW VASRD §4.71a.  There are 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, 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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00900.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings