RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03771
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050815

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

CI CONTENTION:  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 - 20050421	VARD - 20051202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma and Allergic Rhinitis	6602	10%	20050324	
Seasonal Allergic Rhinitis	Cat II	Allergic Rhinitis	6522	0%		
Chronic Sinusitis		Chronic Sinusitis	6510	10%		
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 initially manifested as cough, congestion, and shortness of breath which were aggravated by exercise and dust.  He was diagnosed with asthma after a pulmonary function test (PFT), and results documented from 12 April 2005 to 7 November 2005 ranged from FEV-1 of 81 to 100% predicted, and FEV-1/FVC of 73 to 85% post-bronchodilator.  

The 1 December 2004 MEB NARSUM, 9 months prior to separation, noted CI complaints of chronic congestion and cough, and an abbreviated respiratory examination documented clear lungs.  Current medications included Flovent (inhalational anti-inflammatory medication), and albuterol (inhalational bronchodilator) to be taken as needed.  The examiner diagnosed mild persistent asthma and prescribed an increase in Flovent to 2 puffs per day.  The 21 April 2005 Formal PEB (FPEB) indicated the CI had been on oral steroids since 23 January 2004 (19 months) and was “currently medicated on Singulair, Flonaise, Prednisone (oral steroid), Guaifensin with Codine and an Abuterol rescue inhaler.” [sic]  

A pulmonary function examination on 28 April 2005, 4 months before separation, documented CI reports of wheezing and coughing with exercise.  Current medications included oral steroids, Flonase, Singular (oral bronchodilator therapy) daily, and albuterol as needed.  An STR entry on 26 July 2005, 20 days prior to separation, recorded the use of Singular for a chronic condition.  The CI’s 5 May 2005 memorandum to the Secretary of the Air Force Personnel Council (SAFPC) rebutting his FPEB findings, indicated he was taking steroids and other medications to control his respiratory condition and included an email from his otolaryngologist (consultant to AF/SG) noting he had a “complex triad of aspiring sensitivity asthma and nasal polyps.”  The 13 June 2005 SAF/MRBP memorandum stated that “Since the member's asthma symptoms reportedly have now ‘resolved’ with the use of an inhaled corticosteroid (Flovent), the Board finds that his condition does not reach the threshold for the 30 percent disability rating required for placement on the TDRL.”  

At the 2 December 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported typically experiencing coughing symptoms when running.  He occasionally used Flovent and albuterol to treat his cough and bronchitis, and had used them within the last month.  However, he no longer took oral steroids.  He described episodes of coughing for 10 minutes without wheezing (which he considered asthma attacks) that responded to albuterol.  A treatment note on 30 January 2006, 6 months after separation, noted CI complaints of cough, shortness of breath and wheezing 7 days a week.  He reported not utilizing a spacer to administer his asthma medication and current prescriptions were not addressed.  Lung and chest examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma, bronchial), based on the medication use detailed in the FPEB and SAFPC excerpts above.  The VA also rated the asthma 10%, coded 6602, based on the C&P examination, citing the 10% criteria for asthma.  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.”  Although PFT results did not support a rating greater than 10%, panel members agreed that a 30% rating was supported by the CI’s use of Flovent at the time of separation.  A higher 60% rating was not justified in the absence of documented 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, coded 6602.

Contended PEB Conditions:  Seasonal Allergic Rhinitis and Chronic Sinusitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  Any overlap in symptoms of the CI’s unfitting asthma were considered above.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the asthma, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended seasonal allergic rhinitis and chronic sinusitis, the panel recommends no change from the PEB determinations as not unfitting.  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:

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

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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-2017-03771.

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 in accordance with 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 the 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 90 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, in such a case, failure to render an election will result in automatic enrollment by law.