RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD1201655
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130619
SEPARATION DATE:  20020520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (3E551/Engineering Journeyman) medically separated for asthma.  In 2001, she experienced an onset of respiratory symptoms; eventually diagnosed with asthma and did not respond adequately to treatment to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a permanent profile and referred for a Medical Evaluation Board (MEB).  Asthma, as the sole submission, was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AFI 48-123.  The IPEB adjudicated asthma as unfitting, rated 10%, IAW Department of Defense (DoD) and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI appealed to the Formal PEB (FPEB) which affirmed the IPEB determination; and, then to the Secretary of the Air Force Personnel Council (SAFPC), which affirmed the FPEB determination.  The CI was then medically separated.

CI CONTENTION:  “Medically discharged for asthma currently receiving no asthma benefits.”

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.  The rating for the unfitting asthma condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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.

RATING COMPARISON:

Service Personnel Council – Dated 20020215	VA (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Mild Reactive Airway Disease	6699-6602	0%	20020913	
No Additional MEB/PEB Entries	Other x 3	20020913 	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20021119 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Asthma Condition.  The Board notes that there is a paucity of clinical notes contained in the CI’s submitted service treatment record (STR) and that summary examinations contain transcribed or cited relevant clinical data from other medical reports.  Source documents, to include medication profiles, were not available in records before the Board.  The narrative summary (NARSUM) documents an onset of symptoms, in March 2001, with no preceding history of pulmonary disease.  The NARSUM details a clinical course of intermittent episodes of bronchospasm treated with rescue inhalers, and evolution to a stable condition controlled on maintenance medications.  No hospital admissions or courses of systemic steroids were required.  The final pulmonary function testing (PFT) in service (8 months prior to separation) documented an FEV1 of 92.5% predicted and an FEV1/FVC ratio of 115.9%.  The only relevant outpatient entry in the STR (other than PFT reports) is a pulmonologist’s note dated 14 March 2002 (2 months prior to separation, 2 months after the IPEB).  That note documented the impression, “The patient has bronchial asthma that is fairly well controlled on the present maintenance with Advair and Proventil.”  The provider specified “twice a day” dosing of Advair (inhalational steroid/bronchodilator combination) and albuterol (Proventil, inhaled bronchodilator) “in between off and on.”  The NARSUM noted “relief of all her symptoms” with current treatment; and for current medications quite specifically documented, “The patient is using Advair 500/5 one spray b.i.d. [twice a day], albuterol metered dose inhaler 2 puffs q.4h. [every 4 hours] as needed.”  The AF Form 356 from the IPEB does not reference use of medications.  The FPEB’s adjudication stated, “The member is medicated by Advair and Albuterol (averaging two times per week).”  In her rebuttal, the CI stated, “The statement regarding my use of Advair and Albuterol twice weekly is incorrect.  I have been instructed to take Advair twice daily and Albuterol as needed which on average is about twice weekly.”  The SAFPC decision did not reference details regarding medication use.  At the VA Compensation and Pension (C&P) evaluation (4 months post-separation), the CI remained fully controlled and asymptomatic.  In reference to medications, the examiner simply stated “Now for asthma, she uses inhalers.”  The VA PFT evidence cited an FEV1 of 103% predicted, and did not document an FVC.

The Board directs attention to its rating recommendation based on the above evidence.  The unequivocal VASRD code for rating asthma is 6602.  VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602.  For the reader’s convenience the applicable §4.97 rating criteria for 6602 (asthma, bronchial) are excerpted below:
		FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 
			percent, or; at least monthly visits to a physician for required 
			care of exacerbations, or; intermittent (at least three per year) 
			courses of systemic (oral or parenteral) corticosteroids……………….60  
		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………………….……..30  
		FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 
			percent, or; intermittent inhalational or oral bronchodilator therapy…10 
None of the 60% criteria are in evidence.  The PFT evidence in this case does not support the minimum 10% criteria.  The treatment criteria however, are of primary relevance to this case.  There is a preponderance of evidence, albeit a scant data base, that the CI was prescribed and compliant with daily treatment with Advair.  It is reasonably deduced from the clinical course that the CI’s stable and mild acuity was a result of this treatment.  Daily use of Advair satisfies the 30% criteria.  It should also be noted that the ‘inhalational anti-inflammatory’ criterion, pharmalogically satisfied by Advair, does not specify daily frequency; thus, maintenance use of Advair in itself would support the 30% criterion, even conceding less than daily frequency (as interpreted by the FPEB).  Members agreed, therefore, that despite the mild impairment in evidence, a 30% rating is required to comply with VASRD §4.97 in effect.  It is incidentally noted that the 10% medication criterion was supported by the C&P documentation, conflicting with the VA’s 0% rating determination.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (Reasonable doubt), the Board recommends a 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.  Any concession to DoD guidance is not applied to the Board’s recommendation.  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 her 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 20120829, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXX, DAF
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3770
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-01655.

	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,

XXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN