RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00987
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20050201

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

CI CONTENTION:  “The asthma has become worse and I use medication regularly.  Cervical and thoracolumbar spine and right shoulder have also become worse.”  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 - 20040927	VARD - 20050617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Bronchial Asthma	6602	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary, the CI’s asthma began in September 2003 shortly after arriving at his assignment in England.  Although spring and summer were his worst seasons he had periennial chest symptoms as well.  He was treated with an anti-inflammatory inhaler (Flovent) daily and a bronchodilator inhaler (albuterol) as needed.  

The 16 August 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of difficulty breathing in early spring and summer seasons when his symptoms worsened.  He detailed loss of smell, taste, and problems getting a deep breath.  His cough and wheezing responded to bronchodilator medication, but was worsened by exercise and exposure to grass and dust.  Pulmonary function testing (PFT) performed on 23 June 2004 was normal with no significant response to bronchodilator medication.  Methacholine challenge testing performed on 7 July 2004 was positive (consistent with a diagnosis of asthma).  On the PFT performed on 11 April 2005, the FEV1 was 92% predicted normal and FEV1/FVC was 91%, with no significant response to bronchodilator.  Chest X-rays the same day were normal.  The NARSUM listed current medications of daily Advair (combination anti-inflammatory inhalant medication/bronchodilator medication) and albuterol inhaler, as needed.  The CI reported using his albuterol inhaler daily when not taking his controller medications.  The CI had no steroid burst in the year prior to his MEB, no hospitalizations, and only one emergency room visit for difficulty breathing.  

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 also rated the asthma condition 10%, coded 6602 (asthma), based on the STR, citing PFT and pre-bronchodilator FEV-1 greater or equal to 80% along with intermittent use of an inhaler.  The MEB NARSUM and C&P examinations noted use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision.  At the MEB NARSUM, the CI reported daily use of albuterol when not using Advair.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator and/or inhalational 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 §4.97.  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, the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170221, 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

XXXXXXXXXXXXXXXXXX

Dear Applicant:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00987.

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