RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01920
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150224
SEPARATION DATE:  20050214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Health Services Management Journeyman) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a profile and referred for a Medical Evaluation Board (MEB).  The “asthma” condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded one other condition (obstructive sleep apnea [OSA]) for PEB adjudication.  The Informal PEB adjudicated “asthma” as unfitting, rated 10% citing DoD and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The PEB also listed the OSA, seasonal allergic rhinitis and gastroesophageal reflux disease (GERD) as Category II conditions which are conditions that can be unfitting but are not currently compensable or ratable.  The PEB also listed obesity as a Category III condition which is not separately unfitting nor compensable or ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Have hearing loss, back spine problems caused on duty from fall. Accumulated asthma, allergies, sinusitis and other conditions from service.  Hearing loss evidenced from military flight line duties.  I was an augmentee with Military Police.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

IPEB – Dated 20050107	VA* - (~10 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Obstructive Sleep Apnea with Bronchial Asthma	6602-6847	50%	20051128	
Obstructive Sleep Apnea	Not Unfitting / Cat II					
Seasonal Allergic Rhinitis	Not Unfitting / Cat II	Sinusitis	6513	10%	20051128	
GERD	Not Unfitting / Cat II	GERD	7399-7346	0%	20051128	
Other x1 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20051214 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Asthma Condition:  The CI complained of wheezing and shortness of breath at rest and exercise induced shortness of breath beginning approximately 16 months prior to separation.  After treatment with inhaled bronchodilator medications, his symptoms persisted and he was referred to a pulmonologist.  The pulmonologist performed a methacholine challenge test which was positive for asthma with a 26% fall in forced expiratory volume in one second (FEV1), and a 4mg per liter of histamine concentration.  He was started on daily inhaled corticosteroid medication along with the bronchodilator on an as needed basis with good relief of his asthma symptoms.  The narrative summary (NARSUM) prepared almost 3 months prior to separation noted that the CI had allergic triggers for his asthma symptoms and used avoidance and antihistamine medication for control.  The pertinent pulmonary function tests (PFTs) are summarized in the chart below.  At the VA Compensation and Pension (C&P) exam performed 10 months after separation, the CI reported exacerbations of his asthma several times a year. He was asymptomatic on his medications in between those exacerbations.  His asthma medications were daily inhaled corticosteroids and an inhaled bronchodilator, as needed.  His respiratory exam was only significant for prolonged expiration.  

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

PFTs	PFT ~4 Mos. Pre-Sep	NARSUM ~3 Mos. Pre-Sep	VA C&P ~10 Mo. Post-Sep	
FEV1 (% Predicted)	66%	85%	72%	
FEV1/FVC	99%	83%	83%	
Meds	No mention	Inhaled bronchodilator & corticosteroid	Inhaled bronchodilator & corticosteroid	
§4.97 Rating	30% (FEV1 66%)	30% (Medications; PEB 10%)	30% (VA 50% w/ OSA)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the asthma condition as 6602 (asthma) and rated at 10%.  The VA coded the OSA with bronchial asthma exercise induced asthma as 6602-6847 (sleep apnea syndrome) and rated at 50% based on the required use of a continuous positive airway pressure (CPAP) machine.  The NARSUM and C&P exam both document that the CI was prescribed and using daily inhalational corticosteroids and an inhaled bronchodilator on an as needed basis.  The Board agreed that the CI met the 30% criteria of daily inhalational anti-inflammatory medication.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the asthma condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that OSA, allergic rhinitis and GERD were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Approximately 8 months prior to separation, the CI complained of snoring, daytime somnolence, and episodes of apnea while sleeping.  He was referred for a sleep study that revealed severe OSA.  He was referred for consideration of surgical treatment and a trial of CPAP was recommended.  The CI was given a trial of CPAP which “markedly reduced his symptoms” according to the MEB addendum completed 3 months prior to separation.  The C&P exam also documented that the CI had a “good” response from use of his CPAP machine.  Routinely OSA is not considered unfitting solely on the basis of field and operational impediments to the use of CPAP.  There is no evidence in this case that OSA was associated with any functional impairment that was not corrected by CPAP.  Accordingly, Board members agreed that the PEB’s fitness determination was reasonable; and, after due deliberation, the Board finds insufficient cause to recommend a change in the PEB adjudication of the OSA condition.

The CI’s allergic rhinitis and GERD conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All entries were reviewed and considered by the Board.  There was no performance based evidence from the record that either of these conditions 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 either of these contended conditions and so no additional disability ratings are 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, the Board unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended OSA, allergic rhinitis and GERD conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Asthma	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

				
XXXXXXXXXXXXXXXXXXXX
President
DoD 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-2013-01920.

	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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN