Author: JOHN J. D'ORAZIO
Last saved by: ADA, ROBERT P CIV USAF SAF/MRBD
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD1201438
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130514
SEPARATION DATE:  20020121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (1C151/Air Traffic Controller), medically separated for asthma.   The CI had a history of upper respiratory symptoms starting in 2001, and pulmonary function testing (PFT) indicated results consistent with asthma.  His condition was stable and his symptoms did not interfere with his duties as an Air Traffic Controller.  However, he was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The MEB also identified and forwarded hyperlipidemia and tobacco habituation, identified in the rating chart below.  The Physical Evaluation Board (PEB) adjudicated asthma as unfitting, and rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  Hyperlipidemia and tobacco habituation were determined to be Category III- conditions that are not separately unfitting and not compensable or ratable.  The CI made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION:  “I feel that my rating should be increased due to my asthma has gotten worse over the years since my separation.  I have had several medications prescribed to help control my asthma but have had no improvement long term.  Daily tasks around the home and playing with my children are sometimes challenging since I become out of breath rather quickly.  My lower back has also gotten worse.   Over the years since separation my back pain has gradually increased.   I am unable to stand for long periods of time and can only walk short distances.   I can no longer lift some items without assistance due to pain and low strength in my lower back.   At the time of separation, I originally filled [sic] for disability on both of my knees.   At the time of my disability physical, I was not having pain in one of my knees AT THAT TIME, so I was only awarded one knee at 0%.  I am confused on how I can be AWARDED a disability at 0%.  One would think the minimum would be at least 10%.  In February 2010 I had to have surgery done at the VA to help repair damage to the knee I was declined on.   Since the surgery, the knee I was granted 0% for is having to compensate for the lack of strength and support causing increased pain.   I feel that since it was determined in my favor for the one knee that it should be raised to a minimum 10%, since 0% does not make any sense at all. Perhaps I can be granted both knees for disability as I originally requested at minimum 10% each.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  Ratings for unfitting conditions will be reviewed in all cases.  The asthma as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.  Also IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans’ Affairs, operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20011127 | VA -   (3.5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma | 6602 | 10% | Asthma | 6602 | 10%* | 20020504
Hyperlipidemia | Category III | No VA Entry
Tobacco Habituation | Category III |
No Additional MEB/PEB Entries | Episodic Low Back Pain | 5299-5295 | 10% | 20020504
| 0% X 1/ Not Service-Connected x 2 | 20020504 20020427
Combined: 10% | Combined:  20%
VARD 20020603 (most proximate to Date of Separation) 
* 20021226 Statement of Case based on the original proximate C&P examination confirmed and continued 10%.  No subsequent VARDs in evidence. 

ANALYSIS SUMMARY:  

Asthma Condition.  The PFT evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Pulmonary Exam

MEB ~5 Mo. Pre-Sep
(20010830)

VA ~3.5 Mo. Post-Sep
(20020425)

FEV1 (% Predicted)

pre-treatment  69%
 post-treatment 82%

Pre drug  72%
Post drug 77%

FEV1/FVC

pre-treatment  76%
 post-treatment 80%

pre-treatment  74%
 post-treatment 80%

Meds | Azmacort bid, albuterol prn | Azmacort qid, albuterol prn
§4.97 Rating | 30% | 30%

The CI had a history of respiratory symptoms including coughing, wheezing, and shortness of breath with good response to bronchodilators over several years.  Evaluation with PFT 30 August 2001 demonstrated mild obstructive disease with significant response to bronchodilators noted in the chart.  Allergy evaluation (31 August 2001 and 14 September 2001) confirmed a diagnosis of asthma with tobacco use contributing to symptoms and prescribed twice daily inhaled steroid.  The MEB narrative summary, 1 November 2001, 2 months prior to separation, noted requirement for twice daily inhaled steroid (Azmacort) and inhaled bronchodilator (Albuterol) three to four times a week.  The MEB diagnosis was stable mild asthma, with recommendation to continue as needed Albuterol with twice daily Azmacort.  At the VA Compensation and Pension examination, 4 May 2002, 3 months after separation, the CI reported continued asthma symptoms and use of Azmacort two puffs four times/day and Albuterol inhaler two puffs four times/day.  Lung examination noted wheezes throughout all lung fields.  Spirometry 25 April 2002 is noted in the chart showing mild obstructive defect.  The Board directs attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the CI’s asthma at 10% for mild obstructive lung disease.  Spirometry results support the 10% rating adjudicated by the PEB and VA.  There was no pharmacy record but using data from the treatment record, the Board determined that at the time of final separation from military service, the CI was being treated with daily inhalational Azmacort, a long acting steroid which supports a 30% rating.  There was no evidence for respiratory failure, frequent exacerbations requiring physician intervention, or use of systemic corticosteroids.  Therefore, a higher rating of 60% was not justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a permanent disability rating of 30% for the asthma condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Asthma | 6602 | 30%
COMBINED | 30%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120802, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	XXXXXXXXXXXXXXXXXXXX, DAF
	President
	Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-01438.

	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 Administration 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.  

							Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

PD1201438