RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01219
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060616

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

CI CONTENTION:  In addition to the asthma, the CI 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 - 20060331	VARD - 20061102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was evaluated in November 2004 for a history of recurrent exertional shortness of breath, wheezing and coughing.  He had previously been prescribed Advair (inhalational anti-inflammatory) and also albuterol (inhalational bronchodilator) as required.  Pulmonary function testing (PFT) performed 18 November 2004 revealed moderate restrictive lung disease, possibly attributed to the CI’s inability to take deep inspiration.  There was also evidence of a small airway defect.  A diagnosis of mild restrictive lung disease was made on 1 December 2004, based on the PFT and clinical presentation.  The pulmonologist endorsed continuation of previously prescribed Advair and added daily Singulair (oral bronchodilator).  

According to the pulmonary clinic evaluation on 9 February 2005, the examiner noted that the CI was on albuterol and Advair.  PFTs revealed an FEV1 of 82% and FEV1/FVC of 72%, noted as “normal FVC and FEV1 without airflow obstruction.”  The CI was also given a methacholine challenge test the same day, resulting in “no evidence of airway hyper-responsiveness to support a diagnosis of asthma.”  The 28 February 2006 MEB NARSUM examination, 4 months prior to separation, noted that the CI’s current medications were daily Advair and albuterol as required.  The final diagnosis was “mild persistent asthma controlled with chronic medications for control and as needed albuterol used for flares and prior to exercise.”  There was no VA examination proximate to separation in evidence.  

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.  

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, based on the STR, citing FEV-1 of 71 to 80 percent of predicted value; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy.  The VA also noted that the treatment for the condition was Advair.  The NARSUM, STR and VA rating decision supported the use of Advair proximate to separation.  Advair contains an inhalational anti-inflammatory (fluticasone), and therefore warrant a 30% rating.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).  After due deliberation, considering all 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, 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%	

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01219.

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.