RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01389
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20061113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fire Protection Craftsman, medically separated for “asthma” with a disability rating of 10%.  

CI CONTENTION:  The CI requested review of additional conditions 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 - 20060929	VARD - 20070221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Reactive Airway Disease	6602	10%	20061129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma condition began around May 2005 after he began having respiratory difficulties.  X-ray studies on 16 December 2004 demonstrated a normal cardio mediastinal silhouette and pulmonary vasculature.  There was adequate pulmonary inflation without evidence of effusion, consolidation, or other acute abnormality.  During the emergency room visit on 23 March 2005, the CI was seen for possible asthma attack.  The examiner prescribed Albuterol.  X-ray studies of the chest on 31 March 2005 showed satisfactory inflation of the lungs with no evidence of active inflammatory disease.  

During the 2 August 2005 pulmonary clinic appointment, the physician assistant noted the new onset of asthma may have been related to tree and grass allergens.  The CI was using Flovent and albuterol as needed.    The CI’s medication was changed to Advair 250mg.  The CI underwent a series of pulmonary function tests (PFTs).  On 4 January 2006, 10 months prior to separation, PFTs were normal and showed an FEV-1 of 101% of predicted and an FEV-1/FVC of 84%. On 11 July 2006, 4 months before separation, PFTs showed an FEV-1 of 82% of predicted and an FEV-1/FVC of 77%.  The next day (12 July 2006) PFTs showed an FEV-1 of 100% of predicted and an FEV-1/FVC of 75%.  

The 21 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of a history of several episodes of wheezing over the last year.  The CI reported that these were triggered by exercise or use of his fire protective equipment and the self-contained-breathing-apparatus.  The symptoms included wheezing and minimal coughing until he used the albuterol inhaler, which completely resolved the symptoms.  The CI reported that he had never been hospitalized or intubated for an asthmatic attack.  Examination of the nose showed nasal mucosa without edema or polyps.  It was moist, pink, without lesions.  The lungs were clear to auscultation bilaterally, no wheeze, rales, or rhonchi.  There was good inspiratory effort.  X-ray studies on 31 March 2005 showed satisfactory inflation of the lungs with no evidence of active inflammatory disease.  At the time of the examination the CI was actively taking Flonase and an inhalational bronchodilator prescription of Xopenex.  The examiner diagnosed the condition as asthma, mild-intermittent.  

At the 29 November 2006 VA Compensation and Pension (C&P) examination, 2 weeks after separation, the CI reported asthma and shortness of breath with walking 2 city blocks.  His asthma attacks occurred weekly.  He had never required physician visits to control his asthmatic attacks.  To alleviate the symptoms he used inhaled anti-inflammatory medication and steroid therapy intermittently.  Physical examination of the lungs showed breath sounds as symmetric with no rhonchi or rales.  Expiratory phase was within normal limits.  Chest X-ray studies on 29 November 2006 were also noted as normal.  PFT’s showed an FEV-1 of 89% of predicted and an FEV-1/FVC of 80%.  There was no discrepancy between the PFT findings and the clinical examination.   EKG showed normal sinus rhythm.  The CI was diagnosed with reactive airway disease well controlled on current medication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma condition 10%, coded 6602, based on the C&P examination, citing forced expiratory volume and intermittent anti-inflammatory medication.  There was no PFT evidence (i.e. FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent) to support the 30% rating.  However, panel members concluded that the examinations in evidence reflected current use of anti-inflammatory and 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 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 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 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%	

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 Record  

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01389.

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