RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-06098
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051202

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

CI CONTENTION:  Review all conditions.  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 - 20050830	VARD - 20060523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	30%	20060324	
Migraine Headache	Cat II	Migraine Headaches 	8100	10%	20060307	
Chronic Low Back Pain	Cat II	Chronic Low Back Pain	5235	NSC	20060307	
Seasonal Allergic Rhinitis	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in December 2004 with symptoms of chest tightness and exertional dyspnea (labored breathing/shortness of breath).  She underwent pulmonary function testing (PFT) which was found to be normal.  Pursuant to a strong family history of asthma coupled with the CI’s subjective symptoms, she was started on a trial of Advair (inhalational anti-inflammatory) and albuterol (inhalational bronchodilator).  A Pulmonology consultation performed on 21 April 2005, 7 months prior to separation, diagnosed the CI with severe, persistent, but controlled asthma.   

The 15 June 2005 MEB NARSUM examination, 6 months prior to separation, noted no specific physical complaints regarding the respiratory system.  Her physical examination (PE) was brief and noted normal vital signs and normal peak flows (measurements of how well air moves out of the lungs).  Her current medications included Advair and albuterol.  Prednisone (oral steroid) was also documented with “10mg burst-taper dose as needed for asthma exacerbations.”  

At the 24 March 2006 VA Compensation and Pension (C&P) examination, 3 months after separation.  The CI endorsed symptoms of productive cough and shortness of breath.  The CI stated that she has asthma attacks weekly.  Her respiratory focused PE was normal.  Additionally documented under the CI’s history was, “For her respiratory condition, she requires inhalation of anti-inflammatory medication, steroid therapy daily with the dosage of 25 mg per day and bronchodilator by inhalation intermittently.”
       
A review of the STR noted that oral steroids (prednisone) were cited at 18 and 13 months prior to separation, specifically stating, “prednisone 10mg burst-taper dose as needed for asthma exacerbations” and “patient has prednisone and Zithromax (antibiotic) available for acute exacerbation, should this be needed.”  In January and March 2005, pulmonology encounters noted medication use with Advair and no comment with regards to the use of oral steroids.  A single encounter on 22 February 2005 documented the recommendation of “prednisone 10 mg, 1 pill a day for 5 days.”  One month later, 21 April 2005, the STR revealed inconsistencies with regards to the use of medications whereby the same provider noted “Meds: No” on one document and “medications compliance excellent” on another document the same day.  A primary care encounter dated 18 November 2005 revealed that prednisone was prescribed and was last filled (90 tablets) on 22 February 2005 with one refill.  The prescribing instructions were “take 1 tablet a day when you have asthma.”   Pulmonary function tests performed 12 months prior to separation as well as 4 months post separation revealed values of FEV-1/FVC greater than 70%.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma).  The VA rated the asthma condition 30%, coded 6602, based on the C&P examination, citing 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.  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.”  Panel members first agreed there existed clear and convincing evidence of inhaled anti-inflammatory medication being frequently prescribed by pulmonology and therefore, supporting a 30% impairment rating.  Additionally, due to the prescribing oral steroids, the panel also considered the 60% rating stipulating “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids.”  After extensive deliberation, panel members agreed that pertaining to the prednisone medication, the prescribed usage by the provider of “as needed” and “should this be needed” coupled with directions of taking one tablet a day “when you have asthma,” did not support the 60% criteria threshold.  Therefore, 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.  

Contended PEB Conditions:  Migraine Headache, Chronic Low Back Pain and Seasonal Allergic Rhinitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the asthma condition, the panel recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended migraine headaches, seasonal allergic rhinitis and low back condition, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

Therefore, 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	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-2017-06098.

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  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.