RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03129
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070921

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

CI CONTENTION:    No specific contention made.  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 - 20070716	VARD - 20080303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma…	6602	10%	Asthma	6602	10%	20071103	
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 experienced wheezing, coughing, chest tightness and dyspnea with running during basic training.  On the enlistment DD Form 2807-1 from March 2003, she reported pollen and dust allergies, but denied a history of asthma.  She was first seen in December 2005 for continued shortness of breath (SOB) with running and sometimes walking, and after being treated for bronchitis during basic training.  

According to the pulmonary clinic evaluation on 6 September 2006, 12 months prior to separation, the CI had symptoms consistent with exercise induced asthma.  The examiner noted she had normal examination and spirometry results, but had some components consistent with asthma; subsequent X-rays were unremarkable.  A methacholine challenge from 7 September 2006 was positive and the provider prescribed daily use montelukast (oral indirect-acting bronchodilator), which was filled on 21 September 2006; levalbuterol (inhalational bronchodilator) was noted to be an expired medication.  

At the follow-up pulmonary visit on 21 March 2007, 6 months before separation, the CI reported that she could not run despite medical treatment.  The examiner noted normal pulmonary findings and spirometry tests but that she required inhaled steroids for mild, persistent asthma, and was taking Flovent (inhalational steroid) twice daily and Singulair (montelukast) once daily.   

The 14 May 2007 MEB NARSUM examination, 4 months prior to separation, documented the CI’s chief complaint as asthma.  The examiner noted clear lungs with normal breath sounds and cited pulmonary function tests (PFT) from 17 April 2007, which reported an FEV-1 of 93% and an FEV-1/FVC of 99%.  Current medications included Flovent and Singulair.    

At the 3 November 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily wheezing and dyspnea especially when walking up stairs.  She had a fair response to treatment with medications that included albuterol, Flovent and Singulair.  The examiner documented a normal pulmonary physical examination, and an X-ray revealed no radiographic evidence of acute pulmonary or pleural disease.  Measured PFT’s showed FEV-1 of 86% predicted and FEV-1/FVC of 86% predicted (both post-bronchodilator).    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma condition 10%, coded 6602, based on the C&P evaluation, citing FEV-1 of 71 to 80 percent of predicted value or the FEV1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy.  Review of the STR found no clinical encounters in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was also no evidence that asthma exacerbations were frequent enough to require monthly visits to a physician.  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.”  Inhaled anti-inflammatories (Flovent) were prescribed, as noted by the pulmonary and MEB NARSUM examinations, and at the C&P evaluation, the CI reported her treatment included albuterol, Flovent, and Singulair.  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.  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 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

The following documentary evidence was considered:

SAF/MRB

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XXXXXXXXXX

Dear XXXXXXXXXX,

          Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03129.

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 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.