RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05737
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Nuclear Weapons Apprentice, medically separated for “reactive airway disease” with a disability rating of 10%.  

CI CONTENTION:  “Disability has progressively gotten worse.”  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 - 20080208	VARD - 20081023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reactive Airway Disease	6602	10%	Exercise-Induced Reactive Airway Disease	6602	10%	20080916	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Reactive Airway Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s reactive airway began in November 2007 after the onset of dyspnea and wheezing with exercise, and he was prescribed Xopenex (beta-adrenergic receptor agonist) with instruction to use it regularly and before every exercise or run.  On 7 December 2007, pulmonary function testing (PFT), 5 months prior to separation, showed an FEV-1 of 85% of predicted (FEV-1/FVC was not listed), and spirometry showed mild obstruction.  The 10 December 2007 MEB NARSUM examination noted the CI was taking Zyrtec (antihistamine) and Xopenex.  The Zyrtec had helped with allergy symptoms and he used the Xopenex intermittently, only after heavy exertion with running, and with good relief.  Physical examination showed lungs clear to auscultation with full excursion and no wheezing.  The examiner’s final diagnosis was reactive airway disease with recommended use of Xopenex as needed and no need for a preventative inhaler at that time.  

At the 16 September 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported taking albuterol as needed, but denied having asthma attacks or any functional impairment.  Pulmonary findings were normal, and the examiner documented normal PFTs which showed a post-bronchodilator percent predicted FEV-1 of 76% and FEV-1/FVC of 91%.  
The diagnosis was exercise-induced reactive airway disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the reactive airway disease 10%, coded 6602 (asthma, bronchial).  The VA also rated the reactive airway disease 10%, coded 6602, based on the C&P examination, citing FEV-1 of 76% after bronchodilator and intermittent use of inhalational therapy.  A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy,” and panel members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the MEB NARSUM and C&P examinations.  A 10% rating was also justified by the FEV-1 of 76-percent predicted, as noted by the VA C&P spirometry examination.  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.  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 reactive airway disease.  

BOARD FINDINGS:   In the matter of the reactive airway disease 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.  

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05737.

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.