RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02075
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050705

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

CI CONTENTION:  Rating should be higher.  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 - 20050518	VARD - 20060509	
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’s asthma began in November 2003 with shortness of breath on exertion.  The CI tested negative on a pulmonary function treadmill stress test.  The CI was tested with-and-without exercise.  At the 5 December 2003 primary care clinic (PCC) appointment, the CI complained of ongoing breathing problems.  She reported that her chest tightened up at night and was given an inhaler for use prior to exercise but had been using it at least 4 times a day.  The CI stated she was unable to run without difficulty.  The current medication profile showed the CI was taking fluticasone daily, an inhalational steroid.  She was also taking albuterol as needed.  The examiner prescribed continued use of albuterol and added daily Advair, an inhalational steroid.  

At the 3 February 2004 PCC appointment, the CI complained of shortness of breath with exercise for the past several months.  She had been on asthma medications with some improvement in symptoms, although not completely resolved.  Current prescribed medications were albuterol and Advair.  Examination of the lungs showed some global decreased air movements, with no wheezing, rhonchi or accessory muscle use.  The examiner continued the prescriptions of albuterol and Advair.  Chest X-rays showed the lungs to be clear without focal infiltrates, effusions or pneumothorax.  It was also noted that the CI had borderline cardiomegaly, a heart condition.  Pulmonary function testing (PFT) showed an FEV-1 of 67% of predicted and an FEV-1/FVC of 100%.  There were moderate restrictive abnormalities with no significant improvement with bronchodilator.  

During the 23 February 2004 cardiopulmonary clinic consultation, the examiner noted the history of shortness of breath.  The CI reported that when she ran track, she had to stop because of shortness of breath and chest pains.  The chest pains were reported in the upper central part of the chest with a tightness across the chest going into her neck.  The CI was on albuterol, Advair and Singulair medication at the time and stated that they made her feel somewhat better, but not significantly.  Examination showed the lungs to be clear with normal chest X-rays.  The CI’s PFT and spirometry were noted as normal.  The physician prescribed daily Advair, daily Singulair (oral bronchodilator), and daily Combivent (inhalational bronchodilator).  On 8 March 2004, PFT showed an FEV-1 of 91% of predicted.  During the 2 July 2004 PCC appointment, the CI reported continued breathing problems and reported continued use of albuterol while pregnant.  Her physician had placed her on an inhaler other than Advair while pregnant.  While pregnant, the symptoms were mild enough not be on the steroid.  

The 1 February 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of asthma.  Physical examination showed clear lungs.  There was a positive methacholine challenge test on 10 March 2004.  Current medications were Singulair, Advair and Albuterol.  Diagnosis was asthma with exercise-induced components.  Her symptoms were stable on medications.  On 5 April 2005 (3 months prior to separation), PFT showed an FEV-1 of 81% of predicted.  At the 2 May 2005 PCC visit, the CI reported taking albuterol twice a week except for mild exacerbations but continued to have difficulty with shortness of breath with exercise.  The examiner diagnosed the condition as mild intermittent asthma and refilled the CI’s prescription of Singulair and Advair.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma 10%, 6602, based on the STR, citing forced expiratory volume, or intermittent inhalational or oral bronchodilator therapy.  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 that the cardiopulmonary and PCC examinations reported current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed, as noted by the examiners.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of daily bronchodilator and/or 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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the asthma, coded 6602.  
BOARD FINDINGS:  In the matter of the asthma, 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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Records

	

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02075.

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.

						Sincerely,

								XXXXXXXXXX

Attachment:
Record of Proceedings