RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02403
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070618

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

CI CONTENTION:  “Conditions were worse than thought and causing other issues.”  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 - 20070418	VARD - 20081024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Shortness of Breath Associated with Atopy	6699-6602	10%	Sleep Apnea with Atopic Asthma	6847	30%	20080619	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Shortness of Breath Associated with Atopy.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s shortness of breath (SOB) began in January 2006 with difficulty breathing with exertion (dyspnea).  He underwent comprehensive evaluations by cardiology, pulmonary, and ENT with no cause identified.  Pulmonary function testing (PFT) and methacholine challenge testing were both negative for reactive airway disease.  The CI was tried on various oral allergy medications, including Singulair (also used at times for asthma due to allergies), and Advair (anti-inflammatory inhalant medication).  The Advair was stopped in November 2006 because there was no evidence of a diagnosis of asthma, but albuterol was continued because it provided symptomatic relief.  At a second pulmonary consult in December 2006, the CI reported SOB, especially with wind.  He was using an albuterol inhaler as needed and oral allergy medication (Zyrtec).  The pulmonary specialist noted the CI had been on Singulair but was now off it.  Physical examination of the heart and lungs was normal.  Allergy testing indicated allergy to dust mites and environmental allergies were believed to explain his symptoms.  The pulmonary specialist prescribed Singulair and Zyrtec but at a follow-up on 8 March 2007, noted the allergy medications were not helpful.  He also noted that the CI reported doing well in other geographic locations and that further evaluation by an allergist may be required.  The active medications in the STR listed a prescription for Singulair (montelukast) last filled on 3 January 2007 with no refills.  On 16 March 2007 Singulair was no longer listed as an active medication.  Active medications listed in the STR on 16 March 2007, 30 April 2007, and 8 May 2007 included a bronchodilator inhaler (levabuterol – related to albuterol), Zyrtec and loratidine (Claritin).

The 12 April 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of dyspnea on exertion.  Physical examination of the heart and lungs was normal.  Medications were albuterol inhaler as needed, Claritin and Zyrtec.  The CI listed Zyrtec, Singulair and an inhaler on the DD Form 2697, Report of Medical Assessment, dated 30 April 2007.  

At the 19 June 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported current treatment for atopic asthma with albuterol inhaler as needed, and that he used it approximately twice per week.  Under the discussion for allergic rhinitis the CI indicated he used Claritin or Zyrtec for seasonal nasal congestion and sneezing.  He reported response to treatment was good.  Physical examination of the heart was normal but there was diffuse wheezing noted in the lungs.  A baseline PFT on 1 July 2008 was normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SOB condition 10%, analogously coded 6699-6602 (asthma), citing Zyrtec, Singulair, and albuterol on an as-needed basis.  The VA rated the SOB condition 30%, coded 6847 (sleep apnea), based on the C&P examination, citing results of examination and PFT.  The VA noted asthma and sleep apnea were rated together because the functional limitation arising from the separate conditions manifest in a single respiratory disability.  

The MEB NARSUM and VA examinations showed evidence of intermittent inhalational bronchodilator therapy warranting a 10% rating.  Although the CI listed Singulair among his medications on the DD Form 2697, there was no evidence of ongoing use after a prescription refill on 3 January 2007 and the cessation of use was supported by the CI reporting Singulair provided no benefit in March 2007.  Singulair was not listed on the MEB NARSUM or C&P examinations.  The panel concluded the CI was not using Singulair daily at the time of separation and there was no PFT evidence to support the next higher 30% rating under code 6602.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the SOB condition.  

BOARD FINDINGS:  In the matter of the SOB condition and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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-2017-02403.

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,

		

Attachment:
Record of P