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AF | PDBR | CY2012 | PD 2012 01967
Original file (PD 2012 01967.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2012-01967
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140410
SEPARATION DATE: 20060623


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was an active duty SSGT (2A571/Aerospace Maintenance Craftsman) medically separated for asthma. This condition could not be adequately rehabilitated to meet the requirements of his Air Force Specialty or satisfy physical fitness standards, so he was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The pulmonary condition, characterized as “asthma, mild persistent” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123, with no other conditions submitted by the MEB. The PEB adjudicated “asthma, mild persistent” as unfitting (Category I), rated 10%, referencing the VA Schedule for Rating Disabilities (VASRD). The CI initially did not agree with the PEB adjudication and appealed to the Formal PEB (FPEB), but after consultation with his counsel, retracted the request for the FPEB and concurred with the findings of the Informal PEB. He made no further appeals and was medically separated.


CI CONTENTION: “Asthma Rating at 10%. During Methacholine challenge my FEV-I dropped by 54% at 1 cc. The technician ceased the test at 1 ml/mg as he felt that testing past this would result in a dangerous drop. The best result was taken. The condition has not improved and has resulted in lost time from work and limitation of lifestyle. I have been receiving daily inhalational bronchodilator therapy (Salbutamol) and inhalational anti-inflammatory corticosteroid medication (Seretide 125 - combination of Fluticasone & Salmeterol) both administered through a spacer device since separation in June 2006. I was on QVAR from Feb 2006 til May 2006 and Advair 250/50 from May 2006 to June 2006. I have bought my prescriptions since 2006.”


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 scope of review remain eligible for future consideration by the Board for Correction of Military Records. 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 Disability Evaluation System has neither the role nor the authority to compensate for future severity or complications of conditions that resulted in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws. The Board considers 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.

RATING COMPARISON :

Service IPEB – Dated 20060324
 VA - (3 Wks. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma, Mild Persistent 6602 10% Asthma 6602 10% 20060604
No Additional MEB/PEB Entries
 Other x 10
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 70804 .


ANALYSIS SUMMARY:

Asthma Condition. The CI was initially evaluated in early 2006 by the allergy clinic for a possible wheat allergy. He was noted to have a several-year history of shortness of breath with exertion for which he had been given an Albuterol inhaler (a medication for asthma.) He was a non-smoker. Baseline pulmonary function tests (PFTs) were normal and he was referred for provocative testing with Methacholine. This test was positive; he was diagnosed with mild, persistent asthma based on reported symptoms. He was issued a P4 profile and referred to the MEB. The MEB narrative summary was dated 2 days later on 9 February 2006. The CI noted periodic use of Albuterol for symptoms and also using it prior to exercise. He denied a prior history of asthma or hay fever. It was recommended that he continue the Albuterol as needed and start an inhaled steroid twice daily. The MEB, on 22 February 2006, found the asthma did not meet retention standards. The PEB adjudicated the asthma condition as unfitting, coded 6602 for asthma and rated at 10%. The internal medicine appointment for separation on 28 April 2006 noted continued use of Albuterol but that he had stopped the inhaled steroid. This regimen was working for him and he was advised to continue it. He was seen on 15 May 2006 with an exacerbation of symptoms and, according to the clinic note, was placed on a different inhaled steroid. This exam also recorded use of Albuterol 4-5 times per day. However, the treatment plan also dated that day only listed the Albuterol as needed. The VA Compensation and Pension examination performed on 21 June 2006 (2 days prior to separation) was not in evidence. The VA rater noted in the 4 August 2007 decision that the CI took medications less than twice a week, but did not specify what they were. As he was rated at 10%, the use of Albuterol vice an inhaled steroid is implied. The action officer observed that an inhaled steroid should be used daily whereas Albuterol, a “rescue” inhaler for acute symptoms can be used as needed. Another examination, dated 4 June 2007, noted the CI had used an inhaled steroid daily and Albuterol as needed, but did not indicate when he had begun this regimen.

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the asthma condition at 10% using the code for asthma, 6602. The difference between an adjudication of 10% or 30%, if PFTs are normal, is the medication usage. At the time of separation the CI used a medication twice a week (per the VARD). While he had been prescribed inhaled steroids (which are used daily to be effective) on multiple occasions, other notes indicate the use of only Albuterol as needed had been prescribed. The Board majority determined that the evidence does not support the regular use of an inhaled steroid at separation or any medication more than twice a week. This is consistent with a 10% rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded there was insufficient cause to recommend a change in the PEB adjudication 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 surmised from the record, or PEB ruling in this case, that no prerogatives outside the VASRD were exercised. In the matter of the asthma condition and IAW VASRD §4.100, the Board, by a 2:1 majority, recommends no change in the PEB adjudication. The minority voter did not elect to submit a minority opinion. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121210, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                                   
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

 XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-01967.

         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 appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,



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

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