RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02407
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150331
SEPARATION DATE:  20050608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for an asthma condition.  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 temporary P4 profile and referred for a Medical Evaluation Board (MEB).  “Moderate persistent asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “asthma” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB also adjudicated an obesity condition as Category III (a condition that is not separately unfitting and not compensable or ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  “After separation, Department of Veterans Affairs informed me that service branch errored [sic] in the disability rating assessment.  Department of Veterans Affairs corrected and increased final rating to 40%.”

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 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 20050331	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	0%	STR**	
Other x 1 (Not In Scope)	Other x 3	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20051206 (most proximate to date of separation [DOS])
**VA utilized the Service treatment record (STR) review for diagnosis only in order to grant service connection

ANALYSIS SUMMARY:

Asthma Condition.  Treatment records evidence that the CI presented to the emergency department on 17 October 2003 with reports for difficulty breathing, cough, and mid-sternal chest pain.  He was diagnosed with reactive airways disease exacerbation and treated with oral steroids and an Albuterol inhaler.  He was also diagnosed with atypical pneumonia and bronchitis.  A treatment note dated 18 February 2004 noted that the CI continued with to experience difficulty breathing which was relieved by use of the Albuterol inhaler.  Pulmonary function testing dated 9 March 2004 demonstrated results consistent with a diagnosis of asthma.  A primary care note dated 17 August 2004 documented reports of trouble breathing at night and after running 3/4 of a mile.  A diagnosis of asthma was rendered.  The CI was continued on Albuterol as needed and Flovent twice per day.  During a primary care evaluation dated 3 February 2005 the examiner opined that the CI’s asthma was uncontrolled.  Flovent was discontinued and the CI was started on Advair; Albuterol was continued.  The narrative summary noted a diagnosis of moderate persistent asthma.  Asthma medications listed with Albuterol two puffs every 4 hours as need and Advair 250/50 twice a day.

The CI failed to report to his scheduled VA Compensation and Pension examination on 26 September 2005.  The pulmonary evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Pulmonary Exam	Exam ~15 Mos. Pre-Sep
(20040309)	Exam ~7 Mos. Pre-Sep
(20041105)	Exam ~6 Mos. Pre-Sep
(20041208)	VA C&P ~33 Mos. Post-Sep
(20080320)	
FEV1 (% Predicted)	59	37.6	68.3	100	
FEV1/FVC	--	49.1	84.1	80	
Meds		Flovent (inhaled corticosteroid) daily and Albuterol as needed 	Advair daily and albuterol as needed	Albuterol as needed and Advair daily	
§4.97 Rating	30%	30%	30%	#%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the asthma condition as unfitting with a disability rating of 10% coded 6602 (asthma).  The VA rated the asthma condition at 30%.  Pulmonary function testing and inhalational anti-inflammatory medication criteria were met for a 30% rating IAW VASRD §4.97.  There was no evidence of FEV-1 or FEV-1/FVC pulmonary function test criteria, 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 for a higher rating.  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.  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 6602IAW VASRD §4.97.

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 20131104, 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 (Section 1554, 10 USC), PDBR Case Number PD-2013-02407.

	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