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AF | PDBR | CY2013 | PD-2013-02584
Original file (PD-2013-02584.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: pd-2013-02584
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150421
SEPARATION DATE: 20040830


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Vehicle Operations 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 P3 profile and referred for a Medical Evaluation Board (MEB). “Mild/moderate persistent asthma” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “asthma” as unfitting, rated 10%, citing use of the Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines. An additional condition, hypertension , was determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “Diagnosed with PTSD with Stressor From 2002 Deployment TO Saudi. Asthma and Hypertension increased after tests performed By VA”


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 20040606
 VA – Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Asthma 6602 NSC* STR
Hypertension Not Unfitting Hypertension 7101 NSC* STR
Other x 0
 Other x 0
RATING: 10%
 RATING: NSC
Derived from VA Rating Decision (VA RD ) dated 200 50502 (most proximate to date of separation ) ; CI did not show for exam .
*VARD dated 20070213 granted service connection and rated code 6602 at 10% & 7010 at 0% effective 20061020 .



ANALYSIS SUMMARY:

Asthma Condition. Six months prior to separation, the CI experienced chest tightness, shortness of breath, and coughing both at night and along with activity. Although his exam was normal, he was referred for further evaluation. Later that month, he underwent a methacholine challenge test which resulted in an early positive test consistent with the diagnosis of asthma. He was prescribed inhaled bronchodilator and corticosteroid medications. There were no additional pulmonary function tests (PFTs) until well after separation. The narrative summary prepared almost 2 months prior to separation noted the following: “A pulmonary function test was ordered and was done on 24 February 2004 demonstrating increased bronchial hyper-reactivity with methacholine challenge. Pt. was then placed on Advair 250mcg and albuterol inhaler pm. in which pt. is currently on.” His physical exam was normal as was his plain film chest X-ray. He was diagnosed with mild/moderate persistent asthma.

The VA Compensation and Pension (C&P) exam was not performed until 28 months after separation and stated that “in Service used to take Advair and Singulair.” At that time, the CI was only using his inhaled bronchodilator medication on an as needed basis. He was still smoking cigarettes daily and his pulmonary exam was normal. Two weeks later he underwent PFTs with completely normal results.

The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the asthma as 6602 and rated at 10%. The VA also applied the 6602 code though they initially did not grant service-connection due to the CI not showing up for his C&P exam. The next C&P exam was performed 28 months after separation and the VA granted service-connection with an asthma rating of 10%. The CI was prescribed a daily inhaled corticosteroid medication (Flovent) 6 months prior to separation. 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 the hypertension condition was 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. The hypertension condition was not profiled or implicated in the commander’s statement and was not identified by the MEB. All STR entries were reviewed and considered by the Board. There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance. After due deliberation, and 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 the hypertension contended condition and so no additional disability rating is 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 hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting; therefore, cannot recommend it for additional disability rating. 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%
RATING 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131203 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-2013-02584 .

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

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