RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-01160
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060221

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

CI CONTENTION:  “I’ve been diagnosed for PTSD and depression and attended therapy for trauma while in service and after.  I feel that I should be re-evaluated for both.”  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 - 20060104	VARD - 20070122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	20060718	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s asthma condition began sometime between 2003-2004 when she was running a physical fitness test outdoors while the lawn was being mowed.  She developed chest tightness and immediately sought medical care.  The CI reported that she was wheezing and was treated with albuterol (inhalational bronchodilator) which alleviated her symptoms.  She continued to have symptoms mainly when she exercised outdoors near grass.  She was able to participate in her Air Force duties and fitness protocols except for the run, which she was able to do indoors provided she had a rescue inhaler.  There were no intensive care unit or emergency room (ER) visits, intubations or steroid bursts given for her asthma condition.  She was referred to pulmonology for consultation and the RAST (radioallergosorbent test – a blood test used to test allergies) was positive for grass, tree and cat allergies.  She did not have a methylcholine or exercise challenge test.  She was diagnosed with reactive bronchospasm related to her allergies by the pulmonologist.

On 8 June 2005 the CI was evaluated in the local civilian pulmonology clinic.  The examiner noted that the CI had been given Flovent (inhalational anti-inflammatory).  The examiner also noted that the CI had been prescribed albuterol in the past but had not used it consistently.  The 8 July 2005 pulmonary function test (PFT) showed an FEV-1 of 107% of predicted and an FEV-1/FVC of 110%.  

At the August 2005 pulmonology consult, the CI reported feeling relatively well.  The examiner noted that the CI’s chest was clear but her PFTs showed mild restriction, but otherwise no air flow obstruction (actual test results not in record).  The RAST showed she was allergic to Bermuda grass, perennial rye grass, oak, mugwort and cats.  The examiner noted the bronchospasms were most likely secondary to allergies and added Singular (oral bronchodilator).  She also gave her albuterol to be taken on an as-needed basis.  

At the 20 August 2005 MEB NARSUM examination, 6 months prior to separation, as-needed albuterol was listed as a current medication for asthma symptoms.  Her diagnosis was reactive bronchospasm induced by allergies and exercise.  

The pulmonology MEB addendum on 5 December 2005, 3 months prior to separation, revealed the CI had no ER visits, hospitalizations or intubations for her asthma.  The CI reported that she was using her albuterol inhaler about 50% of the time when she did cardio exercise and there was no usage or wheezing in any other situation.  The examiner noted the PFT, done the same day, showed FEV-1 of 88% and FEV-1/FVC of 106% with “normal expiratory flows and a normal FVC.”  She had a current prescription of as-needed albuterol and the examiner prescribed daily Singular.  There was no medication profile in evidence.

At the 18 July 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the examiner noted the CI was no longer taking any medications.  She had moved to a different location in California.  She reported a PFT done in December 2005, but the records were not available to the examiner.  The examiner noted the CI complained of very rare symptoms which were exercise induced but she could not state how frequently they occurred.  Symptoms were alleviated by rest.  She noted she was no longer being treated for this condition.  A diagnosis of mild intermittent asthma was rendered.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication.   

The panel directed attention to its rating recommendation based on the above evidence.   The PEB rated the asthma condition 10%, coded 6602.  The VA rated the asthma condition 0%, coded 6602, citing the CI was no longer using medication and had normal PFTs.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.” Although the NARSUM addendum noted Singular (daily oral bronchodilator) had been added to her treatment regimen, the C&P examination noted the CI was no longer taking any medications due to rare symptoms.  Panel members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the STR.  There was no PFT evidence to support the next higher 30% rating.  Likewise, a 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or current use of inhalational anti-inflammatory medication.  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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01160.

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.