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-2017-05916.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05916
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Public Health Journeyman, medically separated for “mild persistent asthma” 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 - 20050509	VARD - 20051025	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Persistent Asthma	6602	10%	Asthma	6602	30%	20050831	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% or NA	

ANALYSIS SUMMARY:  

Mild Persistent Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced shortness of breath (SOB) and coughing in September 2003.  She was diagnosed with asthma by a pulmonologist on 7 June 2004 based on a positive methacholine challenge test, with normal baseline spirometry, but a significant 22% decrease in forced expiratory volume in 1 second (FEV-1).  She was treated with daily inhaled, oral bronchodilators, and a daily anti-inflammatory inhaler.  In February 2005, spirometry showed borderline obstruction with an FEV-1 of 96% predicted normal and an FEV-1/forced vital capacity (FVC) of 75% predicted normal.  At an allergy visit on 1 March 2005, the CI was positive on skin testing for multiple allergens, including dust, grasses, and trees.  Immunotherapy was recommended and she was considering treatment after the completion of the MEB.  In the year before separation, the CI experienced multiple exacerbations of asthma requiring emergency room treatment, which included intermittent courses of oral steroids three times on 27 August 2004, 24 February 2005, and 12 April 2005.  The 31 March 2005 MEB NARSUM examination, 3 months before separation, noted complaints of productive cough and SOB, and current medications included:  Flovent (anti-inflammatory inhaler) twice daily, Singular (oral bronchodilator) daily, albuterol as needed, and Serevent Diskus (inhalational bronchodilator) twice daily.  The heart and lung examination was normal. 

At the 24 August 2005 VA Compensation and Pension (C&P) general examination, 2 months after separation, the examiner noted a medical history of asthma.  Current active medications included a daily anti-inflammatory inhaler, daily oral bronchodilator medication, and a bronchodilator inhaler as needed; as well as, nebulization treatments and oral steroid therapy as required.  At the 31 August 2005 C&P respiratory examination, the CI complained of coughing at night and productive cough in the morning, SOB, and wheezing when walking uphill.  She reported using nebulized albuterol, an anti-inflammatory inhaler, and oral bronchodilator.  Physical examination of the heart and lungs was normal, and pulmonary function testing showed an FEV-1 of 91% predicted and FEV-1/FVC ratio of 74% predicted, with a significant response to bronchodilator medication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma, bronchial).  The VA rated the asthma condition 30%, also coded 6602, based on the C&P general examination, citing daily use of inhalational therapy.  Panel members agreed there was STR evidence of “intermittent (at least three per year) courses of systemic…corticosteroids” in the 12 months before separation to support a 60% rating.  There was no evidence of “FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications” for a higher rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 60% for the asthma condition.

BOARD FINDINGS:  In the matter of the mild persistent asthma, the panel recommends a disability rating of 60%, 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	
Mild Persistent Asthma	6602	60%