RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01707
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141107
SEPARATION DATE:  20051212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (Personnel Security Specialist) medically separated for mild persistent asthma with exercise induced components.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty Code or to satisfy physical fitness standards.  She was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The asthma condition, characterized as, “mild persistent asthma with exercise induced components” was identified by the MEB as meeting retention standards and the CI was returned to duty.  The CI wrote a letter of exception, to the Director of Clinic Serves, for her initial MEB findings.  A subsequent MEB also identified and forwarding “mild persistent asthma with exercise induced components” to the Physical Evaluation Board (PEB) in accordance with (IAW) AFI 48-123.  The Informal PEB (IPEB) adjudicated “asthma, mild persistent” as unfitting, rated at 10%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Although not forwarded by MEB, the IPEB identified and adjudicated three additional conditions (seasonal allergic rhinitis; hyperthyroid [resolved] and history of depression) as Category II.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 IPEB – Dated 20051021 | VA - (6 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma, Mild Persistent | 6699-6602 | 10% | Asthma | 6602 | 30% | 20060601
Other x 0  (Not in Scope) | Other x 3 | 20060601
Combined:  10% | Combined:  30%
Derived from VA Rating Decision (VARD) dated 20060626 (most proximate to date of separation)

ANALYSIS SUMMARY:

Asthma Condition.  Review of the service treatment records (STR) reveal that the CI entered active military service with a brief history of a respiratory ailment, treated in part with a prescribed inhaler, but her entrance examination had specified “no asthma.”  Eight months after enlistment in February 2004, she presented with syncope (fainting), dyspnea (difficult breathing) on exertion, “exertional dizziness” and “chest discomfort with running.”  Extensive evaluation resulted in a diagnosis of asthma and seasonal allergic rhinitis, initially treated with Flovent (“daily inhaled steroids”) twice daily, later treated with Singulair (oral anti-inflammatory), Advair (inhaled combination of bronchodilator and inhaled steroid) and Albuterol inhaler.  A pulmonary function test (PFT), dated July 2004 (17 months prior to separation), revealed the presence of “significantly reversible FEV1 [forced expiratory volume] consistent with reactive airway disease.”  Repeated PFT (7 months prior to separation) while prescribed inhaled steroids, revealed no reversible airway reactivity.  Chest X-ray images was normal.  The CI P4 profile (5 months prior to separation) noted the CI with restrictions on running and recommended MEB.  A previous S4 profile due to depression was changed at this time to S1; that is, no duty or mobility restrictions due to any mental condition.  The commander’s memorandum to the MEB noted that the CI could not carry a weapon due to her condition, and did not recommend returning her to full duty.

At the MEB exam, the CI reported that she was “unable to perform her duties” and “unable to exercise to a level that would allow her to pass her fitness test.”  At the time of her MEB, her prescribed medications included Flovent (inhaled steroid) inhalation twice daily and Albuterol inhaler prior to exercise and as needed.  The MEB physical exam noted a normal respiratory rate at rest and a normal lung examination.  The MEB narrative summary (NARSUM) (5 months prior to separation) noted a diagnosis of “mild persistent asthma, with exercise induced component.”  The MEB dated 5 August 2005 (performed 4 months prior to separation) recommended a return to duty.  After the NARSUM had been completed, service treatment records noted that the CI’s medication was changed, adding Advair (inhaled combination of bronchodilator and inhaled steroid) twice daily instead of Flovent, but without subjective improvement.  Two Medical Board Reports (AF IMT 618) exist, one dated 5 October 2005 (2 months prior to separation) and the one in August which recommends return to duty and shows the CI’s signature with letter of exception attached.  The IPEB (7 weeks prior to separation) found the CI unfit for continued service due to “asthma, mild persistent.”  On her DD Form 2697, Report of Medical Assessment (dated 5 weeks prior to separation), the CI reported asthma as the only condition which limited her ability to work and listed her current medications.

A VA Compensation and Pension (C&P) examination, (performed 6 months after separation), noted the CI’s history of asthma.  At the VA C&P examination, the CI’s lung examination was normal.  The VA diagnosed “reactive airway disease” controlled on current medication and with no history of emergency room visits.  The CI’s PFTs were ordered for the C&P examination, but the results were neither included as evidence for this Board to review nor referenced in the VA Rating Decision.

The Board directed attention to its rating recommendation based on the above evidence.  The IPEB found the CI unfit due to mild persistent asthma and recommended separation with a rating of 10% under VASD code 6699-6602.  The VARD, dated 7 months after separation, awarded 30% under VASRD Code 6602, noting that a 30% rating was indicated due to the CI’s use of daily inhalational bronchodilator (Albuterol and Advair) and inhalational anti-inflammatory medication (Flovent or Advair).  The service treatment records notes that PFTs confirmed the diagnosis and severity, as required by DoDI 1332.39, §E2.A1.2.12 (as noted following VASRD Code 6602).  The CI had been diagnosed with asthma and had been repeatedly prescribed bronchodilator and “daily inhaled steroids” (anti-inflammatory medication), conditions which meet the VASRD criteria for a 30% rating under code 6602.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30%, under VASRD code 6602, for the mild persistent 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.  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 mild, persistent asthma condition, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.96(d).  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
Mild, persistent asthma condition | 6602 | 30%
COMBINED | 30%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131021, 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-2013-01707.

	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.

							Sincerely,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR

PD-2013-01707