RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02344
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070926

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

CI CONTENTION:  His condition should be rated at 30% for use of inhaled anti-inflammatory medication.  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 - 20070813	VARD - 20080207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20071030	
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 first developed intermittent respiratory symptoms in 2005.  Asthma was diagnosed in May 2007.  The 26 April 2007 pulmonology evaluation, 5 months prior to separation, showed prescription of daily QVAR (inhalational anti-inflammatory medication) and Singulair (oral indirect-acting bronchodilator).  The STR showed these medications last refilled on 25 May 2007, 4 months prior to separation.

The 25 June 2007 MEB NARSUM examination, 3 months prior to separation, noted daily QVAR and Singulair usage, but Proventil (inhaled bronchodilator, albuterol) usage was no more than once weekly.  Pulmonary function testing (PFT) showed an FEV-1 of 94% of predicted and an FEV-1/FVC of 86% (normal lung volumes, diffusion capacity and forced vital capacity).  He was functioning well at work and able to run without problems.  Physical examination was within normal limits.  Lungs were clear bilaterally with no wheezing.  Review of the STR did not find evidence of asthma exacerbations frequent enough to require monthly visits to a physician.  A 20 August 2007 record review, 1 month prior to separation, did not list an active pulmonary medication.  A 25 October 2007 PFT, 1 month after separation, showed FEV-1 at 96% of predicted and FEV-1/FVC at 85%.

During the 30 October 2007 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the examiner noted the CI was taking inhalational anti-inflammatory medication (exact type not specified) very rarely.  There was no PFT performed because the examiner indicated it was not necessary.  The examiner documented the CI rarely or not regularly used his inhaler or oral medication because he had no problem with his asthma.  Pulmonary examination was unremarkable.

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 C&P examination, citing oral bronchodilator or intermittent inhalation therapy.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy,” while the 30% rating requires an “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.”  Inhalational anti-inflammatory medication does not require daily use.

The panel majority found no evidence of QVAR, Singulair or albuterol prescription after 25 June 2007.  Both the C&P and NARSUM examinations showed normal respirations and clear lungs.  The C&P examination noted the CI used his anti-inflammatory inhaler rarely or not regularly.  The PFT, 1 month post-separation, showed normal lung volumes, diffusion capacity and forced vital capacity.  Although the CI admitted to the rare use of inhalational anti-inflammatory medication, the panel majority agreed that the preponderance of evidence supported the 10% asthma rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.

BOARD FINDINGS:  In the matter of the asthma and IAW VASRD §4.97, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent submitted the appended minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

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 Treatment Record

MINORITY OPINION:  The minority voter recommends a 30% rating for the CI’s asthma condition.

The CI’s inhalational anti-inflammatory therapy (QVAR four puffs three times a day) was initially prescribed by a pulmonologist on 26 April 2007.

The 25 June 2007 MEB NARSUM, 3 months prior to separation, documented CI’s continued use of QVAR decreased to two puffs twice daily.  “Current Medications:  QVAR (inhalational anti-inflammatory) two puffs daily.”  There was no subsequent STR revoking this inhalational anti-inflammatory medication.

The C&P, 1 month after separation, documented “Basic Medical Treatment(s):  Inhaled anti-inflammatory (Intermittent) [drug not specified].”  The examiner documented the CI continued to use his inhaler on a rare or irregular frequency.

The pulmonary, MEB NARSUM and C&P examinations documented the CI continued to utilize a prescribed inhalational anti-inflammatory medication on a daily, rare or irregular basis.  VASRD 6602 criterion does not give a specific frequency to support a 30% asthma rating.  The minority voter therefore concedes VASRD §4.3 (reasonable doubt) on the basis that the CI was prescribed and continued to utilize an inhaled anti-inflammatory medication at the time of separation, and recommends a disability of 30% for the asthma condition, coded 6602.

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02344.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings