RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03386
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Tactical Aircraft Maintenance, medically separated for “asthma”  with a disability rating of 10%.  

CI CONTENTION:  “The issue for which I was rendered unfit was chronic persistent asthma.  At the time of my separation I personally knew several people in the Air Force and other branches of service who were successfully serving and had asthma.  In short, my career was stolen from me.”  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 - 20060718	VARD - 20070504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma (Moderate Persistent)	6602	10%	Asthma	6602	10%	20070205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported having asthma-like symptoms for many years, but worse symptoms after moving from in 2000.  The CI first sought medical attention in early 2006.  On 30 January 2006, 8 months prior to separation, pulmonary function testing (PFT) showed an FEV-1 of 97% of predicted and an FEV-1/FVC of 100%.  According to the primary care clinic/PFT follow-up evaluation on 21 February 2006, 7 months prior to separation, the CI reported worsening and more frequent symptoms of shortness of breath (SOB) over the past 2 years but especially over the past 6 months.  His symptoms were worse at night but not necessarily when lying down. They were also worse with outdoor exercise.  He was able to run indoors on a treadmill without developing symptoms.  He had no chest pains but occasional wheezing. There was a history of seasonal allergies and family history as his father and brother had asthma.  There was no history of childhood asthma or difficulty breathing and he was a non-smoker.  

At the allergy clinic appointment on 13 March 2006, 6 months prior to separation, the CI noted continued SOB, and wheezing that occurred with exercise daily, and frequently at night.  He reported using his albuterol a few times per day for these symptoms.  He was able to pass his fitness test with the help of the albuterol pre-medication.  He was not yet on profile for this condition.  The examiner provided the diagnosis of “moderate persistent asthma.” Physical examination showed the CI with an oxygen saturation of 99% and he was in no apparent distress.  Pulmonary examination revealed normal respiratory effort without accessory muscle use.  Lungs were clear to auscultation bilaterally, with good air movement.  The examiner noted that “given the extent of his symptoms, I will plan for a short burst of oral prednisone along with starting Advair.” He further recommended use of albuterol every 2-4 hours as needed for 3 days and then as needed only thereafter.  The CI was set up for asthma education and pulmonary function monitoring.  The examiner did note that the CI had a “good prognosis for continuing to be able to perform his military duties, assuming he is compliant with asthma medications and follow up appointments.”  His medications were prednisone 50mg tablets for 5 days, trial of Advair 250/50 1 puff bid, and albuterol as noted above.  

The 26 May 2006 MEB NARSUM examination, 4 months prior to separation, noted that the CI was taking albuterol, Advair and Singulair.  The most recent PFT was done on 13 March 2006, 6 months before separation, and showed and FEV-1 of 84% of predicted and an FEV-1/FVC of 78%.  Physical examination showed the CI with an oxygen saturation of 99% and in no apparent distress.  Pulmonary examination noted normal respiratory effort without accessory muscle use.  Auscultation was clear with good air movement, bilaterally.  Review of the STR showed one clinical encounter in evidence documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was no evidence in the STR that asthma exacerbations were frequent enough to require monthly visits to a physician.  There was no evidence showing a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medication. The CI’s medication profile dated 7 September 2006, less than one month before separation showed that the CI was prescribed Singulair, Atrovent, albuterol (Proventil) and Advair.  He had a one-time prescription of Prednisone 50mg for 5 days in March 2006 noted in his record as well.  

At the 5 February 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the examiner noted that the CI had not required emergency department visits or hospitalization for his asthma and had not been treated with oxygen or oral corticosteroids.  He had been prescribed Montelukast daily, Flovent and later Advair twice daily.  The CI noted that Advair caused tachycardia so he limited his treatment to his albuterol inhaler.  The examiner noted that the CI had failed to report for his scheduled PFTs.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the asthma condition 10%, coded 6602.  The PEB cited “IAW Department of Defense and Veterans Administration Schedule for Rating Disabilities guidelines.”  The VA cited “forced expiratory volume in one second (FEV-1) of 71 to 80 percent of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV-1/FVC) of71 to 80 percent; 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.”   The panel placed greater probative value on the MEB examination because it was more consistent with outpatient notes.  Panel members considered that the examinations in evidence reported a current prescription and use of daily bronchodilators.  Inhaled anti-inflammatories were also prescribed and used, as noted by the allergy clinic and NARSUM.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of 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.  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:

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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-2017-03386.

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.

					

		
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