SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05216.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05216
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070507

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

CI CONTENTION:  Review requested of additional 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 – 20070323	VARD – 20070925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma…	6602	10%	Asthma	6602	10%	20070628	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s asthma symptoms were initially treated in the emergency room in August 2006 after experiencing shortness of breath (SOB) for 2 days.  After further reporting “chest heaviness,” pulmonary evaluation on 22 September 2006 revealed normal baseline spirometry, but a positive methacholine challenge indicated the presence of asthma.  

The 4 January 2007 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of intermittent SOB.  He reported he “rarely used his Albuterol inhaler,” with the last use approximately 6 weeks prior to the NARSUM examination.  He only noticed rare symptoms of SOB when exposed to cigarette smoke or vehicle exhaust.  He exercised on a regular basis and was able to wear a gas mask without difficulty.  Physical examination showed bilateral, clear sounding lungs.  The examiner documented “asthma, mild intermittent.”

At the 28 June 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI required an intermittent inhalational bronchodilator.  There was no requirement for outpatient oxygen therapy, immunosuppressive medication, inhalation of anti-inflammatory medication, bronchodilator by mouth, or oral/parenteral steroid therapy.  Physical examination showed symmetric, clear breath sounds, and pulmonary function testing (PFT) demonstrated an FEV-1 of 85% predicted, and FEV-1/FVC at 100%, after the CI provided good effort.  On 28 June 2007, X-rays showed normal lungs, and the radiologist reported no acute cardiopulmonary disease.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma 10%, coded 6602 (asthma, bronchial).  The VA also rated the asthma 10%, coded 6602, based on the C&P examination, citing intermittent inhalational bronchodilator therapy.  Members agreed that a 10% rating was justified by the intermittent use of inhaled bronchodilator therapy, as documented on the MEB NARSUM and VA examinations.  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.  Likewise, a 30% rating was not justified in the absence of daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication.  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 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 and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  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: