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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-2017-05003.

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 (210) 565-2273 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.

						Sincerely,

		

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05003
BRANCH OF SERVICE:  air Force	SEPARATION DATE:  20020125

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

CI CONTENTION:  That pulmonary function testing warrants a 60% rating and that seasonal allergic rhinitis be reviewed.  He also requested other conditions be reviewed that were 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 - 20011001	VARD - 20020623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Persistent Asthma	6602	10%	Asthma	6602	60%	20020411	
Seasonal Allergic Rhinitis	Not Unfitting	Allergic Rhinitis	6522	0%	20020411	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record (STR) and MEB Narrative Summary (NARSUM), the CI initially reported occasional wheezing and chest tightness with allergy symptoms and not exercise.  He had daily chest tightness and was started on Azmacort (inhalational anti-inflammatory) and Proventil (inhalational bronchodilator) without relief.  However, there was a marked decrease in his symptoms after using Advair (inhalational anti-inflammatory).  The 12 September 2001 MEB NARSUM, 5 months prior to separation, showed use of daily Advair and well-controlled asthma symptoms.  Physical examination showed clear lungs with good air movement, but mild wheezing during forced exhalation.  The pharynx was clear with +2 edema of the nasal mucus membrane and minimal clear mucus drainage.  He was diagnosed with moderate persistent asthma and allergic rhinitis.  

The 4 October 2001 MEB NARSUM addendum, 4 months prior to separation, indicated that asthma had been increasingly difficult to control due to ABPA (Allergic Bronchopulmonary Aspergillosis) and the CI had two emergency department visits within 24 hours during August 2001 (not noted in the earlier NARSUM) requiring frequent nebulizer treatments and a burst of systemic steroids.  He was using albuterol (inhalational bronchodilator) four to five times a day.  Recorded medications were Advair twice daily, albuterol as needed (inhalational therapy), Singulair daily (oral anti-inflammatory) oral prednisone (systemic corticosteroid) for a 14-day burst.  The 25 November 2001 allergy/immunology follow-up examination, 3 months prior to separation, documented medication use of daily Advair, daily Singulair and as needed albuterol which was being used daily.  The CI still had nocturnal awakening due to wheezing four times in the past 3 weeks.  The plan was to switch Advair to QVAR (inhalational anti-inflammatory) plus Serevent (inhalational bronchodilator).  A MEB mental health NARSUM, dictated on 18 January 2002, 7 days prior to separation, listed pulmonary medications of daily theophylline (oral bronchodilator), salmeterol (ihalational bronchodilator) twice a day, Advair twice a day and montelukast (oral bronchodilator) daily.

At the 3 April 2002 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported having a great deal of trouble breathing while currently taking Serevent daily, Advair twice-a-day, albuterol four times a day and Singulair once a day.  He reported 8-10 emergency room treatments in the last year.  Physical examination revealed widespread inflammatory reaction in both nostrils with hypertrophic turbinates bilaterally and serous exudate in both nostrils.  The lungs had expiratory wheezing, but were clear on inspiration.  Pulmonary function testing (PFT) conducted on 11 April 2002 and others considered by the panel summarized in the chart below.

Pulmonary Examination	~7 Mo. Pre-Sep	~4 Mo. Pre-Sep	~4 Mo. Pre-Sep	~4 Mo. Pre-Sep	VA ~2 Mo. After-Sep	
FEV1 (% Predicted)	81	100	89	83	47	
FEV1/FVC	65%	72%	64%	71%	50%	
Meds	Advair; albuterol PRN	STR meds: Advair +	STR meds: Advair +	Advair; albuterol 4x/day; Prednisone burst	Advair, albuterol, Singulair Daily	
§4.97 Rating	30%	30%	30%	30%	60%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial), with likely application of DoDI 1332.39 rating guidance, which differed from VASRD rating criteria.  The VA rated the asthma condition 60%, coded 6602, based on the C&P examination, citing FEV-1 of 47 percent of predicted value.  Panel members considered that all of the examinations in evidence proximate to separation reported a current prescription and use of inhalational anti-inflammatory medication, and the preponderance of examinations supported daily use of oral or inhalational bronchodilators.  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, and/or daily inhalational or oral bronchodilator therapy.

The next higher 60% rating requires “FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids.”  The CI had fewer than three courses of systemic corticosteroids in the prior year and less than monthly visits to a physician for required care of exacerbations.  The recorded C&P PFT values were a significant outlier to the numerous STR PFTs that supported no higher than a 30% rating based on PFT results.  Careful scrutiny of the post-separation source of PFT time/volume flow loops additionally raised questions of applied effort and technique.  Therefore, the post-separation PFTs were judged to have decreased probative value over the preponderance of the STR evaluations, and a 60% rating not warranted.  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.

Contended PEB Condition:  Seasonal Allergic Rhinitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or judged to fail retention standards.  The panel agreed there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended season allergic rhinitis condition, the panel agrees it cannot recommend it for additional disability rating.  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	
Moderate Persistent Asthma	6602	30%