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AF | PDBR | CY2014 | PD-2014-00908
Original file (PD-2014-00908.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-00908
BRANCH OF SERVICE: Air Force     BOARD DATE: 20150701
SEPARATION DATE: 20060503


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Financial Manager and Comptroller) medically separated for asthma and chronic low back pain. The conditions could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standard. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded “exercised-induced asthma” to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated “asthma” and “chronic low back pain” as unfitting, rated 10% and 0% respectively. The IPEB also adjudicated “overweight”, “adjustment disorder” and “tobacco habituation” as category III conditions (conditions that are not separately unfitting and not compensable or ratable). The IPEB stated that all ratings were IAW Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines. The CI made no appeals and was medically separated.


CI CONTENTION: “I do not feel everything was taken into consideration, I feel this process was used as a means to reduce manning during ‘force reduction.’”


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 20060322
 VA* - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Asthma 6602 10% Exertional Asthma 6602 10% 20060815
Chronic Low Back Pain 5237 0% Low Back Strain 5237 10% 20060815
Other MEB/PEB Conditions x 3 (Not In Scope)
 Other x 0
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 70409 ( most proximate to date of separation ( DOS ) ) .

ANALYSIS SUMMARY:

Asthma. The CI began having asthma symptoms of dyspnea, cough and chest tightness associated with running in April 2005. She was diagnosed as having exercise-induced asthma, which was treated with albuterol therapy prior to exercise. In May 2005, the CI underwent pulmonary function studies that demonstrated a normal baseline test with a positive methacholine challenge test. Repeat PFS in August 2005 documented a normal study. Service treatment records demonstrated the absence of steroid use and that the CI was prescribed daily inhalational therapy in January 2006 for the condition assessed as asthma, mild, intermittent. The NARSUM dated 8 January 2006 documented three normal pulmonary function studies subsequent to the May 2005 studies. At the time of the NARSUM, the CI’s condition had stabilized clinically without evidence of bronchospasm or emergency care. Physical examination was normal. The physician noted that the CI’s physical profile restricted running and lifting of objects greater than 25 pounds. The CI was able to exercise at her own pace and distance. The examiner assessed exercise-induced asthma and noted the condition was stable and that the CI was able to perform her regular job duties; however, may not have been able to remain on active duty if code limitations apply.

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the CI’s asthma condition as unfitting, coded 6602 (bronchial asthma) at 10%. The VA used service treatment records and records from the VA where the CI was evaluated, and rated the condition of exertional asthma at 10%. The Board noted the CI was prescribed an inhaler for daily use 4 months prior to separation. The Board undertook a careful review of the record and noted the absence of physical findings of shortness of breath, wheezes, bronschospasm, ER visits or hospitalizations for asthma, episodes of respiratory failure or monthly visits to a physician for required care of exacerbations. The prescribing provider for daily inhalation therapy had diagnosed mild intermittent asthma and all other entries in the record, including the NARSUM and VA, diagnosed exercised-induced asthma, mild. Pulmonary function studies were normal in the 6 months prior to separation. The VA documented pulmonary function studies in August 2006, 3 months after separation that recorded FEV1 (111% pred), and FEV1/FVC (88), which supports the 10% rating. The NARSUM documented that the CI’s condition was stable on the intermittent inhalation therapy and noted that her condition at the time had not interfered with her ability to perform her duties, although the condition itself may have precluded continuation of service by policy. All Board members agreed the condition was mild and intermittent and the criteria for 30% were not met. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the asthma condition.

Chronic Low Back Condition. The service treatment record indicated the CI reported that her low back pain (LBP) begun after childbirth, more than a year prior to separation. Treatment records were scarce. The CI was examined at the primary care clinic in late August 2005 and reported that although her sciatica had resolved, her back pain continued mostly when she stood for long periods of time. The CI noted that she ran four times a week, which consists of running five laps and one walk/run lap. She was prescribed physical therapy, but did not attend. She denied pain radiation from the back, numbness and tingling, and physical examination recorded absence of spasm and tenderness, and a normal gait. The examiner assessed chronic low back pain. The NARSUM documented a one year history of LBP that begun after childbirth and noted the CI had participated in physical therapy, and had received medication. Examination of the back was not documented, and no opinion was offered in relation to present condition, prognosis, or impact on duty performance. At the VA Compensation and Pension (C&P), approximately 8 months after separation, the CI reported she could run up to one mile before experiencing LBP symptoms. Radicular symptoms were absent. Her pain was described as daily and intermittent, precipitated by excessive activity, such as running, prolong standing, prolong sitting, with an intensity of 3-10, but could reach as high as 7-8/10. Her pain was relieved with rest and she did not take any medication. Physical examination documented ROM forward flexion of 90 degrees (90), and tenderness to palpation was absent; however, mild right sided spasm was noted in the paraspinal region. Radiographs of the lumbosacral spine in August 2006 were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition 0% coded 5237 (lumbosacral strain). The VA under the same code rated the condition at 10% for spasm. The 10% rating under code 5237 requires forward flexion ROM of less than 85 degrees or combined ROM of the thoracolumbar spine of not greater than 235 degrees, or muscle spasm. The Board reviewed the record in evidence and found no documentation that would support the 10% rating prior to the C&P exam. The C&P exam documented no evidence of loss of function or painful motion. ROM measurements were normal; however, mild spasms were noted. The Board noted there were two back examination of record in consideration (August 2005, 8 months prior to separation) which found absence of spasm, and the C&P exam that noted spasm (3 months after separation). All Board members agreed the C&P exam had greater probative value since it was most proximate to separation. Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the low back pain 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 low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a. In the matter of the asthma condition and IAW VASRD §4.96, the Board unanimously recommends no change in the PEB adjudication. 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, effective as of the date of her prior medical separation:

CONDITION
 VASRD CODE RATING
Asthma 6602 10%
Chronic Low Back Pain 5237 10%
COMBINED
 20%










The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130117, 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-2014-00908 .

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. The office responsible for making the correction will inform you when your records have been changed.


Sincerely,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1. Directive
2. Record of Proceedings
cc:
SAF/MRBR

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