RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-06038
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20050923

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

CI CONTENTION:  “The rating should be changed to reflect medical retirement because of my respiratory issues...”  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 - 20050617	VARD - 20060921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	20051205	
Seasonal Allergic Rhinitis	Cat II	No VA Placement	
COMBINED RATING:  10%  	COMBINED RATING OF ALL VA CONDITIONS:  40%  	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record and MEB narrative summary (NARSUM), the CI reported a 1-year history of shortness of breath, wheezing, coughing and chest tightness associated with exercise and allergens.  Serial pulmonary function testing (PFT) in August 2004 showed an FEV-1 of 99% of predicted and an FEV-1/FVC of 84%.  The following day a PFT showed an FEV-1 of 101% of predicted and an FEV-1/FVC of 84%.  The August 2004 X-ray studies of the chest showed decreased lung volumes with no focal consolidations or effusions.  The cardiac silhouette was within normal limits.  The CI was taking daily albuterol (inhalational bronchodilator).  

At the 9 March 2005 allergy clinic appointment, 7 months prior to separation, the CI reported that strenuous exercise caused a sensation of his “throat closing off.”  A PFT showed an obstructive pattern characteristic of asthma, and after three post-treatment trials his FEV-1 was 98% of predicted and his FEV-1/FVC was 79%. He was diagnosed with mild to moderate asthma and allergic rhinoconjunctivitis.  Advair (inhalational anti-inflammatory) and albuterol were among the medications prescribed.

The 16 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of asthma and as a firefighter was restricted from wearing a respirator for his job.  The CI noted improvement in symptoms since he started taking asthma medications, although he continued having nocturnal symptoms and some shortness of breath with exercise.  He exercised on a routine basis, training for the firefighter combat challenge and used albuterol to get through this.  The CI denied any recent treatment with any oral steroids.  A PFT showed an FEV-1 of 111% of predicted and an FEV-1/FVC of 85%.  During this examination there was no evidence of reversibility because the CI was currently being treated for asthma with Advair and albuterol.  There were no acute signs of cardiopulmonary disease.  At the time of the examination he was using albuterol almost every day plus two or three times per week at night.  There was no wheezing, rhonchi or crackles in the lungs with good air movement bilaterally.  The examiner opined that the report of persistent occurrence of nocturnal symptoms suggested suboptimal control of asthma.  The prescription of Advair was increased to 500/50mcg twice a day due to persistent nocturnal symptoms and albuterol was continued before exercise.  

At the 5 December 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported persistent symptoms of asthma for which he used his inhalers daily.  Physical examination was unremarkable.  At the time of the examination, the CI was taking Advair and albuterol for his asthma.  

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 PEB also listed seasonal allergic rhinitis as a related Category II condition (can be unfitting, but not currently compensable or ratable).  The impairment from the allergic rhinitis was properly subsumed under the overall rating for the asthma condition to avoid pyramiding (IAW §4.14).  The VA also rated the asthma condition 10%, coded 6602, based on the C&P examination, citing daily inhalational therapy with forced expiratory volume of 87% predicted.  

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.”  The panel noted the allergy, pulmonary, and NARSUM examinations all reported current prescriptions and use of daily bronchodilators, in addition to inhaled anti-inflammatories.  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.  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.  There was no PFT evidence to support the next higher 60% rating.  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 §4.97.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Asthma	6602	30%	

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-2017-06038.

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.