RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01552
BRANCH OF SERVICE:  Air Force	BOARD DATE:  20140522
SEPARATION DATE:  20040126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3E031/Electrical System Craftsman) medically separated for an asthma condition.  His pulmonary condition could not be adequately rehabilitated to meet physical retention standards.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The Informal PEB (IPEB) adjudicated the asthma condition as unfitting, rated 10%, while seasonal allergic rhinitis (SAR) was found not unfitting with application of the VA Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB and Secretary of Air Force Personnel Council which affirmed the IPEB’s findings and rating.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “Condition worsening.  I need surgery on both ankles my blood pressure is uncontrolled causing me to be unable to have surgery.  Allergies are still uncontrolled in spite of medication.  I have also, become totally, dependent on asthma medicine.”

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 ratings for the unfitting asthma and not unfitting SAR are addressed below.  The bilateral knees and high blood pressure were not identified by the PEB and are not within the DoDI 6040.44 defined purview of the Board.  These, and any other conditions not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.  The Board acknowledges the impairment with which the CI’s service-connected conditions continue to burden him but notes 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:

SECAF Personnel Council– Dated 20031202 | VA* - Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma | 6602 | 10% | Asthma | 6602 | 0% | STR
Seasonal Allergic Rhinitis | Not Unfitting | Seasonal Allergic Rhinitis | 6522 | 0% | STR
No Additional MEB/PEB Entries within Scope | Other x 0 | STR
Combined:  10% | Combined:  0%
*Derived from VA Rating Decision (VARD) dated 20040923 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Asthma.  The service treatment record (STR) initially reflected that the CI was being worked-up for a respiratory condition noting the first of many spirometry/pulmonary function tests (PFTs) dated 28 August 2002.  In September 2002, he was seen, treated and released from the emergency department after a sudden onset of wheezing, SOB, cough and air hunger.  He was diagnosed with reactive airway disease (RAD) and was to rule-out asthma via a methacholine challenge test (definitive diagnostic test for asthma).  There was no documentation of the challenge test being completed, but rather the record contained many PFTs during 2002 and 2003.  There was no evidence of airway obstruction and the post-exercise PFT of 27 August 2002 also noted “no exercise induced changes.”  All evidenced PFTs were within a normal range.  Despite spirometry results, the CI presented with persistent upper respiratory tract (URT) symptoms to include frequent sneezing, runny nose, post-nasal drip and nasal congestion consistent with allergic rhinitis.  Initially, the CI was prescribed Albuterol (bronchodilator) rescue inhaler for symptomatic SOB and Flonase nasal spray (inhalational steroid; fluticasone) was added in October 2002.  A pulmonology follow-up in May 2003, the CI reported symptom improvement, but still had chest discomfort and cough while running.  His examination was unremarkable and the examiner diagnosed mild exercise induced asthma and continued (previously prescribed) Advair (a daily inhalational steroid/long-acting bronchodilator combination) and added Singulair (oral indirect-acting bronchodilator) to his medication regimen.  At the final pulmonology follow-up on 16 September 2003, the CI reported being off of all medication for several months and the examiner reported the CI as “doing remarkably well.”  The examiner summarized the following:

“[The CI] has had some breathing problems only over the last twelve months since moving to Arizona.  These have subsided and he has had no need for medicines for the last several months.”

His physical exam was normal; the FEV1/FVC ratio was 80%, and the diagnosis was “very mild” RAD.  The pulmonologist noted that “further pulmonary care is not necessary” and the CI’s disposition was without further prescription medication.  An Allergy and Immunology evaluation in December 2003 reported mild URT symptoms and the absence of medication use.  The MEB narrative summary was absent from the STR.  The diagnosis of asthma was forwarded to the MEB.  The STR revealed no history of emergent resuscitation or respiratory based hospital admission.  The commander’s letter was extremely positive in reflecting the CI’s ability to perform all aspects of his military duties and his profile was without physical restrictions.  At the VA Compensation and Pension (C&P) examination performed 7 months after separation, the CI reported very limited respiratory symptoms of chest tightness, SOB and cough occasionally associated with running.  He reported using his bronchodilator rescue inhaler only twice in the previous 90 days; otherwise, he was off all respiratory medications.  “He has Singulair on hand, Advair on hand, but he has used neither one of these.”  Additionally, the examiner noted the CI’s SAR condition was very mild with no significant presentation of symptom recurrence during the past 12 months.  The physical exam was normal.  The STR indicated that the CI “did not report for the PFT” that was ordered as part of the C&P examination.  The nearest PFT to this examination was in December 2003 which was normal.  The VA’s impression was “bronchial asthma,” noting “Service related.”

The Board directs attention to its rating recommendations 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.  Although the PFT corresponding to the final pulmonology follow-up fell within normal limits, its 80% predicted value of FEV1/FVC supported the 10% VASRD criteria (PEB’s rating) level for asthma.  All other PFTs did not support a compensable rating.  The non-PFT derived criteria under 6602 are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; non-daily inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%.  The CI was never placed on oral corticosteroids; therefore, Board members deliberated if the CI’s condition supported the 30% criteria level.  Clearly, the final pulmonology report noted no use of medication for the previous “several months.”  Additionally, the post-separation VA examination noted no medication use (other than the previously mentioned two rescue inhalations) during the prior 3 months.  The Board’s main charge in this case was to determine the use of medication (if any) by the CI at the time of separation in January 2004.  Board members discussed the probative value between the pulmonology report, Allergy and Immunology examination, and the VA examination.  Members agreed that the two pre-separation examinations had the higher probative value for time proximity to the PEB and separation, inclusion of definitive tests (PFT) and were in conformity with VASRD guidelines.  The September PFT of FEV1/FVC of 80% supported the PEB’s 10% rating level.  Absent current medication use or newly prescribed medication, there was no support for a higher impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the asthma condition.

Contended Seasonal Allergic Rhinitis Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the SAR was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Medical literature cites a strong linkage of SAR with asthma.  Board members agreed that the SAR was a concurrent and comorbid condition exacerbating the primary asthma condition.  A concurrent condition of this nature must itself be separately unfitting to merit additional rating.  The SAR was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that the SAR condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the SAR condition and so no additional disability rating is recommended.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the asthma condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended SAR condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130911, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01552.

	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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

							
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

PD-2013-01552