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AF | PDBR | CY2012 | PD 2012 01324
Original file (PD 2012 01324.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2012-01324
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140327
SEPARATION DATE: 20011109


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (1C131/Air Traffic Control Apprentice) medically separated for asthma. The CI presented with complaints of allergic rhinitis in April 2001 and was started on medications. In July 2001, her complaints included dyspnea and chronic coughing. Pulmonology diagnosed her with asthma after an abnormal pulmonary function test (PFT) and a methacholine challenge test (MCT). The asthma condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). Intermittent asthma was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated asthma as unfitting rated 10%. Allergic rhinitis was determined to be a C ategory II condition and t obacco habituation was listed as a C ategory III condition. The CI made no appeals and was medically separated .


CI CONTENTION: “I continue to have pain and difficulties standing for long periods of time, condition has worsened but even with reevaluation they tell me I’m okay, nothing is wrong. Asthma percentage went from 100% at discharge to 30% now”.


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 20010917
 VA - (22.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Asthma 6602 100% 20030924
No Additional MEB/PEB Entries
 Other x 5 20030924
Rating: 10%
 Combined: 100%
Derived from VA Rating Decision (VA RD ) dated 200 20130 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System (DES) 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 (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Asthma Condition. The CI was diagnosed with asthma in 2001 in response to a MCT (reversed with a bronchodilator). The pulmonologist prescribed Serevent (inhalational bronchodilator; salmeterol) and Flovent (inhalational steroid; fluticasone) twice daily and Albuterol (bronchodilator) rescue inhaler on an as needed basis. There were no further clinical records within the service treatment record other than those as part of the DES process. The undated MEB narrative summary performed presumably sometime in August 2001, approximately 3 months prior to separation, summarized the history leading up to her current diagnosis and did not provide any further subjective complaints. It referenced her original PFT from August 2001 and erroneously documented the results to indicate a total drop in lung function “of” 70% rather than a reduction in lung function “to” 70%. This erroneous information was carried through the DES and, the board believed, became the basis for the VA’s 100% original rating. Her physical examination and chest X-ray were normal. The diagnosis was mild intermittent asthma currently controlled and the examiner noted current occupational ability with continued treatment. There was no history of emergent resuscitation, hospital admission, or intermittent courses of systemic steroids. There were no pharmacy authored medication profiles in evidence.

At the VA Compensation and Pension (C&P) examination performed 22 months after separation, the CI reported a frequent nighttime productive cough and shortness of breath in walking three blocks or climbing two flights of stairs. The physical examination was normal and a current PFT indicated mild “restrictive” disease verse “obstructive” pattern commonly found with asthma. The diagnosis was “history of asthma, well controlled at present.” The PFT evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

DOS 20011109
Pulmonary Function
MEB/civi lian lab
~ 3 Mo. Pre-Sep
VA ~ 22.5 Mo. Post-Sep
FEV1 (% Predicted)
 72 % * 89%
FEV1/FVC
 87 % 90 %
Meds
 No asthma medications Albuterol As needed
§ 4.97 Rating
 10% 10 % **
* Based on PFT criteria alone; ** Based on treatment criteria .

The Board directs attention to its rating recommendations based on the above evidence. The unequivocal VA Schedule for Rating Disabilities (VASRD) code for rating asthma is 6602. VASRD §4.97 defines both PFT-derived criteria and clinical treatment criteria for rating under 6602. The remoteness of the available VA C&P examination justifies probative value given to the MEB examination and its single PFT obtained three months prior to separation. The MEB PFT criteria of 72% met the level of 10% disability rating under 6602. The non-PFT derived criteria under 6602 are: “intermittent inhalational or oral bronchodilator therapy” for 10%; “daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication” for 30%; and, “intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids” for 60%. Having no evidence of systemic steroids, the 60% criteria was not met. Board members deliberated if there was sufficient evidence for the 30% rating.

Board members discussed and agreed that the original PFT in August 2001 was indeed documented in error; repeated (copied) in subsequent documents and was cited as the basis for the VA’s original rating decision. The evidence, albeit from a scant data base, overcomes reasonable doubt that the CI was prescribed and compliant with daily treatment of Seravent and Flovent. Daily use of either of these medications satisfies the 30% criteria under 6602. In its findings, the PEB did not contradict this. 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.

Other PEB Conditions. Allergic rhinitis was adjudicated by the PEB as a Category II condition (can be unfitting, but not currently compensable or ratable). The Board unanimously agreed that the condition was related to and included with the discussion above and therefore did not warrant consideration as a separately unfitting condition. Any related symptoms and or functional impairments were subsumed under the rating 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 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 her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Asthma 6602 30%
RATING
 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120626, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


 PDBR PD-2012-01324



MEMORANDUM FOR THE CHIEF OF STAFF
         Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:
         The pertinent military records of the Department of the Air Force relating to XXXXXXXXXXXXXX , be corrected to show that:

                   a.  The diagnosis in her finding of unfitness for Asthma, VASRD code 6602, was rated at 30% rather than 10%.

                   b.  On 9 November 2001, she elected not to participate in the Survivor Benefit Plan.
                  c.  She was not discharged on 9 November 2001 with entitlement to disability severance pay; rather, on that date, she was released from active duty and on 10 November 2001, her name was placed on the Permanent Disability Retired List.








XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

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