RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01829
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060222

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

CI CONTENTION:  “Disability should have been rated higher because this was a service-connected illness.”  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 - 20060105	VARD - 20061213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20061018	
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 was first evaluated in January 2005 after a 6-month history of shortness of breath and coughing with exercise.  A trial of albuterol (an inhalational bronchodilator) was recommended.  In May 2005, she experienced a syncopal episode and an exercise treadmill evaluation had to be stopped due to dyspnea (shortness of breath).  An echocardiogram showed mitral valve calcifications and trace regurgitation of the mitral, tricuspid and pulmonic valves.  Subsequently, she had an exercise-challenged test for bronchospasm on 27 October 2005, 4 months prior to separation with findings of “significant exercise-induced bronchospasm” and audible wheezing.  She had an FEV1/FVC baseline of 92%, which dropped during the testing to 82% and 89% and recovered to 90% with treatment.  Albuterol and Flovent (an inhalational steroid) were prescribed on 29 November 2005.  

The undated and incomplete December 2005 MEB NARSUM examination, approximately 2 months prior to separation, noted the CI was taking albuterol and Flovent for the diagnosed exercise-induced asthma.  Physical examination showed lungs clear to auscultation bilaterally and no wheezes.  The heart had a regular rate and rhythm.  At a 30 January 2006 dental appointment, 1 month before separation, the examiner noted the CI had been prescribed both albuterol and Flovent for asthma; however, the examiner was silent regarding the frequency of use.  

At the 18 October 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported using both albuterol and Flovent and had not experienced any asthma symptoms while on the treatment.  Physical examination showed the lungs clear to auscultation and the heart had a regular rate and rhythm without a murmur or gallop.  Pulmonary function testing (PFT) performed the same day was within normal limits and revealed an FEV 1 of 83.5% predicted and FEV/FVC of 91%.  

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 use of a daily inhalational bronchodilator and anti-inflammatory medication.  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 the examinations in evidence and the reported current prescriptions and use of inhaled anti-inflammatories, which are not specified as a daily requirement under the 30% rating provision as noted by multiple examiners.  Members of the panel 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 were no PFTs in 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 §4.97.  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

XXXXXXXXXX
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XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01829.

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.