Another Asthma Question

R

rowleycf

PEB Forum Regular Member
Yep...yet another person who is new here looking for information on the MEB process for asthma.

Background: Nearly 11 years in, Force Support (Personnel) Officer. Approx one year ago I came down with a bad case of pneumonia and bronchitis. Since then, I have had difficulty breathing and have been referred to a pulmonologist who diagnosed me with asthma via spirometry test.

I am currently on Flovent 220mcg (two puffs twice a day), Singulair, and Xoponex for rescue inhaler. This week I will most likely put on Advair, as the Flovent and Singulair alone are not controlling my attacks. I've been placed on prednisone intermittently (3 or 4 times) since Feb 2009. I used to run marathons (last one was two months prior to pneumonia), now I can't run a mile or walk up a single flight of stairs without getting severely winded and having to stop. Passed the PT test with pu/su/waist only; however, I had a bad attack and the PTL administering the test had to practically carry me to my office to get my rescue inhaler. I've been on a no running profile since Nov 2009 and it lasts through Apr 2010.

I have several commendations and awards, even recently a WG Qtrly Award, and I am concerned how this may affect my MEB outcome. You see, my commander is very happy with my performance, but I am in a one-deep 100% deployable position and am pretty sure I will at least be deemed with a ALC-1 rating if retained. Additionally, I have not put on the gas mask recently, and I am concerned that I may have difficulty at this stage even keeping that on. I know that I have passed every PT test, but I am sure that I won't pass the next one that I do involving the running component.

My commander will help me with the letter. He will be supportive of my desire, whether it is to stay in the AF without the ability to deploy, or to be separated. But I don't think he would want to write a letter that shows me in a negative light as he has a favorable impression of me as a military officer.

The big question is...I'm hoping that I will be medically retired with 30% based on the daily steroids and concerned that the board will look at me as fit for duty. My desire to be medically retired includes the fact that I strongly feel that I will be imposing a severe hardship to the rest of my colleagues by not being able to deploy, but there is no way that I could be in that type of environment. I have invested so many years in the Air Force, but really feel that I will become a hindrance down the road. Sure, I am a good performer now, but how does it affect my unit when I have a bad episode and am out for three days at a time?

Anyone have an idea as to whether this sounds like a fit vs. unfit case and what my way ahead should be? They are just gathering the data for the MEB, so I want to be proactive. Thanks in advance.
 
rowleycf,

Welcome!
As a starting point, yes, your case seems to turn on fit vs. unfit. If unfit, it sounds clear that you will be retired at a 30% minimum rating.

rowleycf said:
Background: Nearly 11 years in, Force Support (Personnel) Officer.
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This will make an unfit finding more difficult to attain. It sounds like you are likely an O4 or thereabouts, and given the support role and somewhat senior grade, your fitness will be judged against a non-combat support position with some seniority. All is not lost, though, if you are looking for an unfit finding.

I am currently on Flovent 220mcg (two puffs twice a day), Singulair, and Xoponex for rescue inhaler. This week I will most likely put on Advair, as the Flovent and Singulair alone are not controlling my attacks. I've been placed on prednisone intermittently (3 or 4 times) since Feb 2009. I used to run marathons (last one was two months prior to pneumonia), now I can't run a mile or walk up a single flight of stairs without getting severely winded and having to stop. Passed the PT test with pu/su/waist only; however, I had a bad attack and the PTL administering the test had to practically carry me to my office to get my rescue inhaler. I've been on a no running profile since Nov 2009 and it lasts through Apr 2010.
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All of this indicates unfitness.

I have several commendations and awards, even recently a WG Qtrly Award, and I am concerned how this may affect my MEB outcome.
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Thous would seem to less impact your MEB than your PEB. This is an issue, because it tends to show you can perform your duties well.

You see, my commander is very happy with my performance, but I am in a one-deep 100% deployable position and am pretty sure I will at least be deemed with a ALC-1 rating if retained. Additionally, I have not put on the gas mask recently, and I am concerned that I may have difficulty at this stage even keeping that on. I know that I have passed every PT test, but I am sure that I won't pass the next one that I do involving the running component.
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Your commander's input will carry a lot of weight. However, if you cannot perform military tasks, this is helpful for an unfit finding. Ideally, you will have a profile restricting your ability to wear Pro-mask, complete PT events, deploy, and perform physical training. If your profile is not accurate, I would consider trying to get this addressed.

My commander will help me with the letter. He will be supportive of my desire, whether it is to stay in the AF without the ability to deploy, or to be separated. But I don't think he would want to write a letter that shows me in a negative light as he has a favorable impression of me as a military officer.
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He does not have to portray you in a negative light, it sounds like all he has to do to pen a helpful letter is accurately describe your physical limitations. Being a good officer and being unfit are not mutually exclusive. You can have great work ethic, technical competence, and leadership and still be unable to physically perform.

Anyone have an idea as to whether this sounds like a fit vs. unfit case and what my way ahead should be? They are just gathering the data for the MEB, so I want to be proactive. Thanks in advance.
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Like I said, I do think that fitness is the central issue. I would continue to be proactive and make sure your MEB is well drafted. Best of luck in getting a good outcome, I hope all goes well for you.
 
Thanks Jason...your insight has been immensely helpful. I'll have everything together, and if they determine it is in the best interest of the AF to keep me even though I may not be able to deploy, then that is their call. I love the military and would hate to simply be separated with a "see ya later!" or kept and viewed as someone just trying to get out of a fitness test or deployment. I know that I have a good work ethic and that I give my all every day, but I have also seen great troops who were looked at differently for no other reason than they were required to stay home while others deployed and they couldn't run. This would be a hard pill to swallow for me, especially trying to lead by example fitness-wise. I will keep you posted on the upcoming events.
 
Your commander's input will carry a lot of weight. However, if you cannot perform military tasks, this is helpful for an unfit finding. Ideally, you will have a profile restricting your ability to wear Pro-mask, complete PT events, deploy, and perform physical training. If your profile is not accurate, I would consider trying to get this addressed.
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Jason, would I have my pulmonologist request that I not wear the pro-gear, PT, deploy, etc. or would my PCM do that? I'm still currently seeing my pulmonologist as we are trying to get my meds under control. I am pretty confident that I can't do the run component on the PT test, but does that mean I go in every time my profile is about to expire in order to renew it? Additionally, who suggests whether I can wear the mask or not? I'm just a little confused as I've never had two docs before and don't want to step on either one's toes during this process as they have both been very supportive.
 
Dear rowleycf,
I was also diagnosed with asthma Nov 9 2009.i Had a FEV of 2.85 wich is 69 % of predicted .I use 4 puffs of Flovent every day and use Ibuteral as a rescue inhalor wich i probaly use once a day.from what i have read on this forum Asthma is a VASRD code 6602 and because i use the inhalors every day the outcome will probaly be TDRL.
I was TDY at FT leonard wood mar-jul 2008 at school and came down with pnemonia and was put on quarters after that i was never the same phisicaly.I spent 5 years in the ARMY and was in a comgat support maintenance unit, we ran probaly 5-6 miles for pt and this was never a problem for me.I have always been a runner and never had problems with pt before.
I am in the Air National Guard although i was on active duty title 10 orders (operation Iraqi freedom ) when I was diagnosed woth asthma. My profile says that I am not deployable and cannot run more than 0.1 miles I havebeen told that because of mf AFSC 3E2X concrete and asphalt repair and heavy equipment and am not deployable i WILL be found unfit.even though my commander wrote a letter stating that my asthma has in no way interferrd with my ability to perform my duties (although my asthma has gotten worse since the letter was written)I also recived an atr force acheivment medal for going to Hawaii ans Isreal ih the last year but being non deployable the acheivements dont mean anything.
My PCM called me in her office Dec 2 2009 and told me that my reecords were going to be fast tracked thru the MEB process .The next day she called me and told me that my records could not be fasttracked because of my AFSC.Mt package (medical records)were sent off to AFPC at Randolph was sent off Dec.9 th 2009 i have been told that it will be April 2010 before we now anything.
I have 14 years in service and my intention was to do 20+ years and retire , although regular retirement is not probably not gonna happen , if the final outcome is TDRL then atleast i will retire medically and acheive my goal of retirement .
I have learned alot from this forum reading the threads of others.I have also learned that you have to learn all you can in order to look out for your best interest because the Air Force aint going to look out for you i have also learned to expect the worst outcome but pray for the best outcome.It sounds like your package will be found unfit and also if you look at the VASRD code 6602 (the way I understand it ) it says that the daily usen of steroids and an FEV of 51%-69% should be rated at a 30% bt the Department of Defence I talked to the VA rep here and was rold that the VA and DOD are two seperate entities and the VA usually rates asthma higher than 30 %.
I would very much like to compare notes because it sounds like our cases seem to be very similar.
Best of luck to you
 
dougcarey568,

Thanks for posting. It's been tough for me to swallow not being able to perform physically how I did before I got sick. I have always identified myself as a marathon runner, and now that may mean marathon walker:( I too have always thought that I would retire from the Air Force, but I see the only way to do so without severely impacting my fellow Airmen is to be medically retired as I still have 9 until I am regular retirement eligible. I have always seen the Air Force in a positive light, and am happy with my treatment thus far; however, this is far too important to sit back and let it play out. I have an appt with my pulmonologist on Friday, and I will let you know then what my FEV test said. I wasn't paying attention to the results, only that he said it definitely showed that I have asthma. Then I found this site and realized that I should know what my records say. I'm also going to request a copy of all of my medical records so I can get my ducks in a row prior to everything going forward. Luckily, my PCM wants to wait until the end of March to formally put in my MEB package, so I've got some time to gather my evidence. I'm also anticipating being put on Advair this week which I believe will help my case as I cannot breathe at night without several rescue puffs of albuterol.
 
rowleycf,
Here is the information i was looking for to share with you,

VASRD code 6602 Asthma, bronchial:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than
40 percent, or; more than one attack per week with episodes of
respiratory failure, or; requires daily use of systemic (oral or
parenteral) high dose corticosteroids or immuno-suppressive
medications 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to
55 percent, or; 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 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to
70 percent, or; daily inhalational or oral bronchodilator therapy,
or; inhalational anti-inflammatory medication 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to
80 percent, or; intermittent inhalational or oral bronchodilator therapy 10

Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record
This information was copied from this forum
I also attended a TAPS (pre-seperation) breifing i found it to be very interesting , so FYI if it is offered at your duty station it would probaly benefit you to attend.
Good Luck
 
Thanks. I have seen this info in other threads as well. Jason said that he's pretty confident I would warrant a 30% rating if found unfit; however, it looks like my records may deem me fit, based on my performance in the job. That is what I am concerned about, but we'll see. I just don't want to be found fit and then have them turn around and separate me for failure to pass a fit test. (I've never failed one, but haven't taken the run component since developing asthma).
 
I'm going through a MEB for Asthma right now and thought I would throw in my two cents on this...

My situation is very similar to yours, as I have NEVER displayed a single sign of asthma in my life, and now have been diagnosed with it having a 40% drop in FEV-1 on my PFT. As far as an unfitting or fit finding goes, I've been getting mixed information on the matter. My doctor has informed me that if an airman is still using their rescue inhaler more than twice weekly they have "uncontrolled" asthma and will be found unfit, simply because the asthma isn't controlled. My PEBLO on the other hand says they simply don't find people unfit for asthma anymore and they will fast track all asthma cases and give them a return to duty with limitation codes attached. I tend to trust my doctor a little more on this, simply because I know some folks that have been found unfit for asthma.

That being said, I would automatically think they will determine a 30% disability right off the bat. A close friend of mine was found unfit at less than 30% and had to fight through a FPEB to get the 30% rating that he obviously qualified for. In his case, he had EVERY quailification needed for the 30% finding and was still found unfit at less than 30% by the IPEB.

My MEB still hasn't been submitted because a cervical disc issue and sleep apnea are being included in my MEB package and I still have ongoing medical appointments associated with them. They won't submit my MEB until all issues have a final diagnosis.

I think however, that if your asthma is trully uncontrolled according to military standards (more than 2 uses of rescue inhaler a week), you should plan on being found unfit, regardless of all the other factors involved. If you are retained with uncontolled asthma, what kind of future can the military expect out of you? No deployments, no PT, state-side only assignments... They have no use for people like us and will have no reason to keep us around. But they also don't want to pay us for the rest of our lives either. I'm going to plan for an unfit finding and taking it to an FPEB to fight for the 30% I'm entitled. I don't think they'll just give it to me right out of the gates.

Good luck and keep us all posted on the progress, I'm sure yours will be completed before mine and I'm very interested in how yours ends up.
 
Thanks for the post...it provides some things to think about. Of course I would fight it if they found me unfit under 30%. I was just bumped to Advair 500/50 and am using my rescue inhaler nightly. I have an appt with an allergy doc to see if there are certain allergens triggering the attacks, but the fitness thing concerns me. I had an attack with the pushups/situps only test and the PTL ended up stopping the test (luckily, I ended up passing anyway) short. As an officer, the consequence of not passing a PT test equals a referral OPR, which can be detrimental to my career. I may be a prideful person, but I don't want to go out that way on a negative and I can see it happening. We'll see.
 
The results are no different for an enlisted member when it comes to the PT test. I received a referral EPR last year for failing my PT test in March. I couldn't run and was placed on a profile afterwards that limited me to AC only. Without a 34 inch waist I failed every time.

I understand your concern about the way folks will look at you. I've been looked at like a slacker for over a year now, even though my profiles have all panned out to be well needed and justified, they still look at me like I'm a slug and treat me like I'm trying to get out of something by having asthma and two slipped discs in my neck. It amazes me how the amount of work and community service you put in means nothing if you have a profile that limits your PT. Somehow you're a "skater" always looking to get out of work!

Good luck on your MEB... Please keep us all posted!
 
Will do...thanks for the message. Helps to know there's others going through similar situations.
 
Just curious...how do you get on a profile long term? I just get put on a profile when I'm really sickly, but they're ready to pounce as soon as I come off it. I believe with the new walk test starting in July, I may be able to do some other cardiovascular exercises to get me to a passing level for that test.
 
Although, I don't have asthma I too am on a profile. Mine is no walking >100 yards, no pushups, sit ups or running. Even when I was at 165lbs during football season in HS when I was in awesome physical shape I never had a 34" waist. I came in awith a 35" waist and a 6-pack (sure wish I still had that...).

****Need PTL/UFPM verification on the next part****
Relief come on 1 july when a 37.5 AC is required to get a 75.5 score (Correct me if I'm wrong but, you take your score and divide it by the total points attainable and you get a percentage.

Example: Exempt from evveything but AC: 37.5" AC = 15.1 pts. 15.1(your score) / 20 (total available on AC) = 75.5% of points available were scored. So this would be a score of 75.5??)
 
I haven't read that far into the new guidelines, but it looks like you are doing the math correctly... Which is great for those that are AC only.

As far as getting a permenant profile or more long term, I really don't know. I've had to have mine updated every 2-3 months and have to go back to the HAWK and get the one I need for the PT manager. It's a major pain in the butt and you have to be diligent in being sure you get the updated profile and an appointment with the HAWK in ample time before you are due to test. They will grab you the second it expires... They just extended mine through June because a definitive diagnosis hasn't been reached on my back and sleep apnea issues. They won't proceed with the MEB until everything is done.

I'm sure someone on here knows, but I'm pretty sure that once your MEB is completed and a determination is made, your PCM can write a profile for an extended period. Until the MEB is done it is considered a temporary problem that should get better. I think that's the point of the MEB is that there is an issue that isn't getting any better. In fact if you are on a profile that limits areas of the PT test for more than a year I think they have to initiate a MEB.

Good luck, keep us posted.
 
Thanks ibucki! Good info. I'll continue to get temp profiles, but almost feel like a hypochondriac going to the doc every two months. It's like I can't win either way. They are initiating a fast-track MEB for me. From what I understand, I'll most likely be RTD for the asthma. I can always hope that they find me unfit, but can't get my boss to understand that even though I do a good job at work, I am hurting myself to maintain that level of competency. I guess they'll look at it each year to determine fitness, so here's for hoping.
 
Question... That last line of your last post makes it sound like they are going to redo a MEB on you yearly to determine fitness... Is that what you are hearing from them?

This whole "fast track" thing confuses me. They informed me of the same thing. Seems to me that if you have asthma that prevents you from running, from wearing a gas mask, and from being deployed or sent to areas where "dust" or "smoke" can exaserbate your problem... You are likely unfit for duty. What use is a soldier or airman that can't do many of the tasks their fellow airman are asked to do?

My PEBLO is making it sound like they hear the word asthma and instantly give you a fit for duty and slap a code-C on you and it's back to life as usual. My doc is telling me it's not that cut and dry and continued use of the rescue inhaler pushes them to find you unfit. Ask your PCM about this, I'd be curious to hear his explination of it. I was told that any more than two uses of the rescue inhaler per week is considered "uncontrolled" asthma and the MEB will refer you to IPEB and will likely find you unfit.
 
ibucki,

I am referring to the yearly Report in lieu of that they are required to do after the MEB finds you fit for duty. At least that's how I think it goes. They just monitor you to make sure nothing's change.

I use my rescue inhaler at least twice DAILY. So maybe that's good news for me, however my PCM says the same thing as your PEBLO...no problem, just a C-Code. If you check out dougcarey568 posts, his fast track MEB was denied and he was referred to a full MEB. I believe it has to do with your AFSC. Mine is Force Support (i.e. personnel, manpower and services). They just merged my career field, so the fact that Services deploys all the time may be in my favor for an unfit finding. We'll see.
 
dougcarey568 said:
Dear rowleycf,
I was also diagnosed with asthma Nov 9 2009.i Had a FEV of 2.85 wich is 69 % of predicted .I use 4 puffs of Flovent every day and use Ibuteral as a rescue inhalor wich i probaly use once a day.from what i have read on this forum Asthma is a VASRD code 6602 and because i use the inhalors every day the outcome will probaly be TDRL.

My PCM called me in her office Dec 2 2009 and told me that my reecords were going to be fast tracked thru the MEB process .The next day she called me and told me that my records could not be fasttracked because of my AFSC.Mt package (medical records)were sent off to AFPC at Randolph was sent off Dec.9 th 2009 i have been told that it will be April 2010 before we now anything.
I have 14 years in service and my intention was to do 20+ years and retire , although regular retirement is not probably not gonna happen , if the final outcome is TDRL then atleast i will retire medically and acheive my goal of retirement .
Best of luck to you
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I'm so glad you posted those numbers because although I had the results of the pulmonary function test, I didn't know what it meant. My FEC/FVC is showing at 64%. When I went to the table for restrictive lung disease (my diagnosis), it also showed a minimum 30% rating. However, they also did a sleep oxygen level test on me and found my O2 levels to be constantly below 89%, and I was prescribed oxygen. Using the same table below, it shows my rating should be 100%. You've given me some added hope. Thanks for that. And for anyone who visits the doctors office and gets a low pulse oximetry reading of less than 92%, you should insist on this overnight oxygen study. When your 02 levels drop below 92%, your blood cells become oxygen deprived which affects your entire body system.

6845 Chronic pleural effusion or fibrosis.

General Rating Formula for Restrictive Lung Disease
(diagnostic codes 6840 through 6845):
FEV-1 less than 40 percent of predicted value, or; the ratio of
Forced Expiratory Volume in one second to Forced Vital
Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity
of the Lung for Carbon Monoxide by the Single Breath Method
(DLCO (SB)) less than 40-percent predicted, or; maximum
exercise capacity less than 15 ml/kg/min oxygen consumption
(with cardiac or respiratory limitation), or; cor pulmonale (right
heart failure), or; right ventricular hypertrophy, or; pulmonary
hypertension (shown by Echo or cardiac catheterization), or;
episode(s) of acute respiratory failure, or; requires outpatient
oxygen therapy 100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; DLCO (SB) of 40- to 55-percent predicted, or;
maximum oxygen consumption of 15 to 20 ml/kg/min (with
cardiorespiratory limit) 60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; DLCO (SB) 56- to 65-percent predicted 30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; DLCO (SB) 66- to 80-percent predicted 10
 
to all of you watching this thread....

I was informed by my PEBLO on Friday that my RILO would be submitted this week (was supposed to be in June), so I should know something by the end of next week..

For those unfamiliar with the RILO, it means "review in lieu of" and is done when a member has an assignment in the system and AFPC needs to decide if they can send the member on the assignment or if a full MEB is warranted. A bad aspect of it is there is NO appeal power provided to the member... If AFPC medical decides you are fit, then you are fit... No questions asked. Tell me they aren't calling down the hall to the assignments office and deciding if you're fit based on the needs of the assignment... That's another topic all together.

We'll see in a week or two, PEBLO says I should know by the end of the week but I'm not holding my breath.

I'll keep you all posted here, this should be a good indication of wether or not the AF finds un-controlled asthma unfitting.
 
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