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

XXXXXXXXXX
XXXXXXXXXX
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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-2017-02710.

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.

						

 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02710
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061030

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

CI CONTENTION:  “Please 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 - 20060911	VARD - 20070308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma 	6602	10%	Asthma	6602	30%	20070104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma began in 2003 following an episode of sharp left sided chest pains and dyspnea with exertion.  Cardiology ruled out pericarditis.  He was seen by pulmonology and was diagnosed with asthma confirmed by pulmonary function testing (PFT).   At the pulmonology clinic visit on 24 April 2006, a PFT showed FEV1 of 87% and a FEV1/FVC of 85%, with a significant response to bronchodilator.  The examiner noted the possibility of mild COPD at that time, but it was unclear if it was asthma or emphysema based on the CI’s history of cigarette smoking since he was 12 years old.  The CI was prescribed daily Advair (inhalational anti-inflammatory) and a bronchodilator inhaler as needed (albuterol).     

According to the 12 June 2006 pulmonology clinic visit the CI had significantly improved on Advair.  PFTs were performed that day and the examiner noted they were normal with an FEV1 of 89% predicted, with no significant bronchodilator response.  The examiner indicated the CI’s history and testing were diagnostic of asthma and no further testing was necessary.  He also indicated that the CI’s atypical chest pain may have been related to the asthma diagnosis.  

The 17 July 2006 MEB NARSUM examination, 3 months prior to separation, noted use of as needed albuterol and daily Advair.  The CI reported the symptoms had improved with Advair.  Physical examination of the heart and lungs was normal, without wheezing noted.  The final diagnosis was asthma, moderate and persistent.   According to the primary care visit on 4 October 2006 for his MEB physical examination the CI reported that his asthma was controlled and that he was using his albuterol inhaler two to three times weekly and Advair twice daily.  There was no STR evidence of respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids or monthly exacerbations requiring physician visits.  

At the VA Compensation and Pension (C&P) examination on 4 January 2007, 2 months after separation, the CI was using a bronchodilator inhaler (levalbuterol) as needed, and an anti-inflammatory inhaler (mometasone furoate), twice a day.  There were no recent hospitalizations reported for asthma.  A PFT was normal, but the CI had used albuterol an hour prior to the test.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602.  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing daily inhalational or oral bronchodilator therapy; or 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 considered the examinations in evidence reported the use of “inhalational anti-inflammatory medication” that meets the 30% VASRD rating criteria.   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.  

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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170320, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record