RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03647
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050319

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

CI CONTENTION:  In addition to the asthma condition, the CI requested review of other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20041217	VARD - 20050908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20050511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma condition began in November 2001 after a respiratory illness.  She was diagnosed with reactive airways disease.  The medication history noted prescription of Proventil (inhalational bronchodilator) but the CI did not use it.  In November 2002, the pulmonary specialist prescribed daily Advair (inhalational anti-inflammatory/bronchodilator combination) and Singulair (oral indirect-acting bronchodilator), in addition to as needed albuterol (inhalational bronchodilator), but the Advair was stopped by the CI prior to June 2003 because it was ineffective.  Singulair was discontinued due to hives (allergic reaction).  The CI noted seasonal exacerbations with associated shortness of breath and further exacerbation with cleaning supplies and perfumes.  The CI had no history of smoking or tobacco use.  

During the 18 May 2004 MEB NARSUM examination, 10 months prior to separation, the CI complained of difficulty breathing.  Physical examination showed lungs clear to auscultation without wheezes or rales.  The examiner indicated the CI continued to do well off all prescription medications with rare, as needed, use of an albuterol inhaler.  Consultation from the pulmonologist who originally diagnosed the CI, recommended albuterol as needed and Advair if frequent or consistent symptoms developed.  

On 7 July 2004 (8 months prior to separation), pulmonary function testing (PFT) showed an FEV-1 of 93% of predicted and an FEV-1/FVC of 112% (essentially normal).  The pulmonary assessment on 9 August 2004, 7 months prior to separation, documented responsiveness to bronchodilators and the examiner stated:  “I have suggested that she use inhaled albuterol as needed.  It may be necessary for her to use an inhaled steroid seasonally but at this time that is not being recommended.  I expect that she will do well and that only the inhaled steroid and inhaled bronchodilator will be necessary for her to remain asymptomatic.”  On 13 August 2004 the Methacholine challenge was positive for asthma.  

At the 11 May 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner recorded the CI had irritation with difficulty of air exchange from the nares and recurrent epistaxis.  The examiner noted the CI was currently on Flovent (inhalational anti-inflammatory), but never required intubation, emergency room visits or hospitalizations.  The PFT showed an FEV-1 of 84% of predicted and an FEV-1/FVC of 110%, with obstructive disease.  Chest X-ray was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (bronchial asthma).  The VA also rated the asthma condition 10%, coded 6602, based on the C&P examination, citing “intermittent inhalational or bronchodilator use” with post bronchodilator PFT results.  

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.”  There was no PFT evidence (i.e. FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent) to support the next higher 30% rating.  The panel deliberated on the 30% VASRD 6602 criteria for use of “inhalational anti-inflammatory medication.”  There is no requirement the CI use inhaled anti-inflammatory medication daily or that a minimum amount be used on days the CI uses the inhaled anti-inflammatory medication.  The criteria is met when the CI uses inhaled anti-inflammatories at least intermittently.  Although there was indication of a possible need for inhalational anti-inflammatory medication (if symptoms changed), there was also indication the CI did not require these medications prior to separation.  The use of Flovent noted in the post-separation C&P examination was adjudged by the panel to be post-separation worsening.  Therefore, the majority agreed that no rating higher than the 10% adjudicated by the PEB was supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends a disability rating of 30% but does not elect to submit a 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03647.

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 Proceedings