RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01940
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140603
SEPARATION DATE:  20050705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (4N0/Medical Services) medically separated for asthma.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The mild persistent asthma condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB adjudicated “asthma” as unfitting, rated 10% with application of the Department of Defense guidelines and VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I have allergy induced asthma and am unable to exert myself and lift objects.  I can not work in a physically demanding career to include healthcare as it sometimes requires lifting and moving patients.  I did not have any problems until my asthma began upon entering the military.”  [sic]

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; 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 20050511 | VA - (1 Mo. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Asthma | 6602 | 10% | Asthma | 6602 | 30% | 20050803
MEB or PEB entries not in scope x 0 | Other x 1 |
Combined:  10% | Combined:  30%
Derived from VA Rating Decision (VARD) dated 20051103 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  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 military 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.

Asthma Condition.  The CI was initially seen by an allergist on 13 September 2004 for evaluation of night-time shortness of breath and chest tightness for a “couple of years.”  Evaluation led to a diagnosis of mild persistent asthma.  A daily inhaled steroid (Flovent) was started on 27 September 2004.  At an allergy/immunology follow-up evaluation on 23 March 2005 (4 months prior to separation) the CI denied coughing at night or shortness of breath with exercise.  He reported using Flovent since September with good results.  He had required a rescue inhaled bronchodilator (Albuterol) only once per month.  He never required Albuterol at work.  The examiner concluded that the CI was “doing well with daily Flovent use.”  The plan was to continue using Flovent twice per day.

The narrative summary on 30 March 2005 (4 months prior to separation) reported that the CI had not required systemic steroids or emergency treatment.  He denied nighttime cough or difficulty with exercise.  The use of daily Flovent and occasional Albuterol was re-iterated.  Pulmonary function testing showed an FEV1 of 81% of predicted and an FEV1/FVC of 94%.  A dental medical history on 3 June 2005 (one month prior to separation) indicated that Flovent was a medication the CI was “presently taking.”  At the VA Compensation and Pension exam performed a month after separation, the CI reported he was using Flovent and an inhaled bronchodilator.  He stated he was “frequently awake at night gasping for air.”  He denied exertion-induced shortness of breath.  The examiner concluded that his asthma was well-controlled with current medications.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition at 10%, coded 6602, while the VA assigned a 30% rating under the same code.  The pulmonary function testing in evidence did not justify a compensable rating.  Although a 10% rating is warranted under this code for intermittent use of inhaled bronchodilator therapy (a requirement met in this case), a 30% rating stipulates “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication.”  Board members agreed that the requirement for and use of inhaled anti-inflammatory medication (Flovent) in this case clearly met the VASRD §4.97 threshold for a 30% rating.  There was no evidence of frequent visits for care of exacerbations or of systemic steroid use; therefore, the next higher 60% rating was not justified.  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.

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.  As discussed above, PEB reliance on Department of Defense guidelines for rating asthma was operant in this case and the condition was adjudicated independently of that instruction by the Board.  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 20131027, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
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-2013-01940.

	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

PD-2013-01940