RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01878
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060721

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

CI CONTENTION:  Review all conditions.  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 - 20060615	VARD - 20070831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20070706	
Seasonal Allergic Rhinitis	Cat II	No VA Placement	
Gastroesophageal Reflux Disease	Cat II	Gastroesophageal Reflux Disease	7399-7346	0%	20070706	
Overweight	Cat III	No VA Placement	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition approximately began in January 2005 with a 2-month history of wheezing, chest tightness, shortness of breath (SOB) and cough.  He also had a history of allergies and gastroesophageal reflux disease (GERD).  Pulmonary function testing (PFT) was essentially normal, but a pulmonology evaluation in June 2005 confirmed the diagnosis of asthma.  The CI was treated with daily Advair (inhalational steroid/bronchodilator combination), Singulair (oral indirect-acting bronchodilator), and albuterol (inhalational bronchodilator); as well as medications for seasonal allergies and GERD.  The CI had two asthma exacerbations documented in the STR following diagnosis and initiation of treatment, and before taking daily Advair; otherwise his asthma was well-controlled on medications.  He also underwent allergy testing which indicated a grass allergy. 

During the 15 May 2006 MEB NARSUM examination, 2 months prior to separation, physical examination was normal without wheezing on forced expiration.  The CI was taking Advair twice daily as well as Zyrtec (antihistamine).  Spirometry performed on 6 April 2006 was normal without significant response to bronchodilator medication.

At the 6 July 2007 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported asthma treated with daily Advair and allergy medications.  He reported no additional asthma attacks and had not required emergency treatment.  He was able to run 1.5 miles 3-4 times per week as part of police training without SOB or chest pain.  Physical examination was normal without wheezing, and chest X-rays and PFTs performed in July 2007 were also normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), citing Department of Defense and VASRD guidelines.  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing inhalational 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 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 reported on the MEB NARSUM and VA examinations.  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.  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.  

Contended PEB Conditions:  Seasonal Allergic Rhinitis (SAR), GERD, Overweight, and Tobacco Habituation.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither SAR nor GERD were profiled, implicated by the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  Overweight and tobacco habituation are conditions that do not constitute a physical disability IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending them as unfitting.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended seasonal allergic rhinitis, gastroesophageal reflux disease, overweight, and tobacco habituation conditions, the panel recommends no change from the PEB determinations as not unfitting.  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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01878.

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.