RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04894
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040526

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

CI CONTENTION:  No specific contention was 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 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 – 20031212	VARD - 20050608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma, Moderate Persistent	6602	10%	Asthma	6602	10%	200#####	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Moderate Persistent Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially sought treatment for complaints of chest congestion, shortness of breath and wheezing in February 2000.  Recurrent symptoms led to evaluation by pulmonology and a formal diagnosis of asthma was established in August 2003.  Treatment included medications of Albuterol (inhaled bronchodilator) and Flovent (inhaled corticosteroid), to be utilized on an as needed and daily basis, respectively.   

The 19 September 2003 MEB NARSUM examination, 8 months prior to separation, provided a history of medication treatment which included Albuterol and Flovent despite the waxing and waning of symptoms with avoidance of certain triggers (specifically, jet fuel).  The NARSUM examiner recommended treatment of albuterol and Flovent.  Clinic visits with the same examiner in February and March 2004, 3 and 2 months prior to separation, noted continued use of Albuterol, Flovent and Advair (inhalational anti-inflammatory medication).

At the 8 March 2005 VA Pulmonary Compensation and Pension (C&P) examination, 9 months after separation, a pulmonary function test (PFT) showed an FEV-1 of 92% of predicted and an FEV-1/FVC of 83%.  At the 23 March 2005 VA C&P general examination, active medications were simply an albuterol inhaler, which the CI used only as needed.

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same VASRD code of 6602 (bronchial asthma), citing no specific reasoning and an “FEV-1 of 71 to 80 percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy,” respectively.

A 30% impairment rating stipulates an “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.”  In this case, inhaled anti-inflammatory medications were prescribed and used, as noted by the NARSUM examiner and subsequent clinic notes by the same examiner in encounters that were nearest to separation.  Therefore, based upon the use of inhaled anti-inflammatory medication, panel members agreed that the VASRD §4.97 threshold for a 30% impairment rating was reasonably satisfied.  A higher 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.  Additionally, there was no pulmonary function test in evidence to support the next higher 60% rating.  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%	

XXXXXXXXX

Dear XXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04894.

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.

						Sincerely,