RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05251
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080317

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

CI CONTENTION:  Review of all conditions requested.  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 - 20080128	VARD - 20081201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Obstructive Sleep Apnea (OSA) with Asthma 	6602	30%	20080825	
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 developed dyspnea and wheezing when running in June 2007.  She was sent for provocation testing (methacholine challenge with 12% reversibility) which confirmed the presence of reversible airway disease and she was started on Albuterol (inhaled bronchodilator).  When the albuterol was ineffective, she was also started on Singulair (oral bronchodilator/anti-inflammatory prescribed daily) in September 2007.  There was no STR evidence for respiratory failure, hospital admissions, continuous requirement for systemic corticosteroids, or monthly exacerbations requiring physician visits (criteria for VASRD ratings higher than 30%).

The 27 September 2007 MEB NARSUM examination, 6 months prior to separation, documented symptoms well controlled with the use of Singulair (oral bronchodilator/anti-inflammatory prescribed daily).  She had no problems with breathing during exercise and was able to run at least 2 miles without difficulty.  The panel noted that the 28 January 2008 Formal PEB remarks, 2 months prior to separation, revealed that the CI had been diagnosed with exercised-induced asthma and had been doing well using Allegra and Singulair until a recent bout of sinusitis and bronchitis resulted in prescription on an inhaled steroid, power nebulizer, and an oral prednisone taper trial.  

At the 25 August 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported fair response to treatment and albuterol as required was listed as medication.  The pulmonary function test in evidence yielded an FEV1 of 92% predicted and an FEV1/FVC ratio of 86%.  At the 23 July 2009 VA C&P examination, 16 months after separation, the examiner noted no abnormal respiratory findings, but documented the use of Advair twice daily, albuterol as required and Singular daily.  

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 rated OSA with asthma 30%, coded 6847 (sleep apnea syndromes:  persistent daytime hypersomnolence), based on the C&P examination, citing persistent daytime hypersomnolence.  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.”  Board members considered that the examinations in evidence up to separation reported current prescription and use of daily oral bronchodilators.  Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied in this case on the basis of bronchodilator and/or inhalational anti-inflammatory medication use in the majority of the examinations through the record.  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 §4.100.  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%	

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

Dear XXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05251.

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.