Asthma

Jason Perry

Jason Perry

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A typical case involves a Soldier who is placed on TDRL for Asthma rated at 30% due to their use of daily inhalational therapy. The Board has one piece of evidence to use in assessing this rating: The Soldier's medication profile or record of filled prescriptions from the pharmacy. A common situation occurs when the Soldier's asthma is the same as when put on TDRL but for whatever reason they do not pick up their prescription regularly. At the re-examination, the doctor looks at the medication profile. If there is no record of monthly prescriptions filled for the medication (usually given 30 days at a time), the Soldier will often be downgraded to 10%. Because of the lack of proof, the Soldier may lose medical benefits. If the Soldier simply went to the pharmacy to fill his prescription, he likely will have been permanently retired.

The lesson to be drawn from this is the importance of complying with treatment and getting your condition documented. The Board will award 30% for this condition, but they can only do so if the right evidence is submitted.
 
VASRD rating criteria (Asthma)

"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. "

The bold criteria above (added) is what most often gets Soldiers rated at 30%. I cannot emphasize enough the importance of keeping your medication profile up to date.
 
New Army Guidance

The APDA published new guidance for rating asthma on 19 June 2007, which I have attached. This does not seem to change much except to clarify use of Pulmonary Function Tests PFTs. In most case, my experience has shown that a higher rating of 30% will come from daily inhalational therapy than from PFTs.
 

Attachments

Article on exercised induced Asthma

http://www.time.com/time/health/article/0,8599,1659046,00.html

Though the PEB correctly presumes that asthma that develops on active duty is not EPTS, this article points to a way to argue service aggravation for asthma if it is noted in a Servicemember's entrance physical. Probably an easier argument for exercise related asthma but still worth raising for asthma with other triggers.
 
Asthma Disability

I'm in the process of be recommended for a MEB/MRB because of my asthma. Since coming back from Germany and arriving in Arizona I have had 12 asthma attacks, currently taking prenisone everyday 3 times a day, singulair, zyrtec, hydrozine, calcium citrate, naproxen, and nexium all for my asthma. On top of taking advir 500mg, Xopenex inhaler, and using a portable nebulizer at home, along with taking my xolair shots once a month and my immunotherapy shots twice every two weeks. If the decision is made to retire me frrom service what percentage would I probably be looking at in terms of disability as I already have 22 years in service.
 
Sounds like you will max out at 75%

nvhollis3,

Welcome to PEB Forum. Sorry to hear you about your condition.

Based on what you wrote, especially that you are taking immunosuppressive therapy, it appears you qualify for a 100% rating. However, the maximum allowed by law for disability retirement is 75%. So, if your condition remains unchanged, it looks like you will be paid 75% of your retired base pay per month.

Please let us know any other questions.
 
I am currently going through a medical board and I'm dying due to the stress! I have been diagnosed with asthma, my FEV-1 was 58% and 75% after a neb treatment. I was told my numbers were too low to continue with the methachlorine test.
I have been on prednisone 6 times in 6 months. Currently on Zyrtec, 500/50 Advair, Inhalor that I use WAY more than I should be and I don't feel like its helping. I've had to go into the emergency room 6 times to have neb treatments.
I'm also waiting for a sleep study to see if I have sleep apnea.
Bottom line. I'm tired. I want to be medically seperated. What are my chances?
Any advice is GREATLY appreciated!
 
Monicat,

Welcome to PEBFORUM, glad to have you here!

This must be very stressful having to deal with your conditions at the same time you have to deal with the administrative process.

It seems likely that you will be separated (at least). I would need to know more to give a definitive answer, but it appears that your use of prednisone would qualify you for a rating of 60%. If you are found to have asthma and rated at above 30%, it is a near certainty that you will be placed on TDRL. So, that only leaves the threshold question, is it unfitting?

It certainly appears that your asthma is likely unfitting. But remember this is determined based on your grade and career field. I suppose there may be some possible factual situation where your condition is not unfitting, but I am having a hard time imagining it.

Sleep apnea, if diagnosed, must also be unfitting before it will be rated. I suggest you read the thread on that condition as the DOD "interprets" (illegaly, in my opinion) the rating differently than VASRD.

Please let us know any questions.
 
Hi Jason!

Well, I'm in the Security Forces career field. Before my deployment, I was active in the squadron sports teams and I was a flight chief on duty. Since I've been back in Oct, I've pretty much been demoted in duty position. I'm not able to run around, we had an exercise on flight. (Simulated response, running, apprehending a subject, etc) and I had a serious asthma attack. I took my inhaler, 2 times, 2 puffs a piece before it calmed down. My supervisor wanted me to go into the medaid station, but it finally subsided but after that, he has me sitting in the control center.
We had squadron training where we had to run around, play GI Joe, defensive drills, etc. Again, another asthma attack.
Is it unfitting? I would have to say yes and so does my supervisor and commander.
I appreciate your help Jason as Im sure everyone else does!

Monica
 
Monica,

I think you will have an unfit finding without a a doubt. If you get to 30% or more (which I think the appropriate rating is 60% now) then you will very likely be placed on the TDRL.

I am not sure about the sleep apnea. If you do get the diagnosis and are prescribed a CPAP, a lot will depend on how you respond to treatment. Often it is not unfitting.

Your welcome, glad to help!
 
Im getting a little nervous. I know each case is unique, but I found something on here stating they don't always base it off of the ablity to do the job you are rated on. Does this mean, I could be found fit?
I just wish I knew what my chances are of getting out. I feel like I'm in some kind of lottery. Has anyone else been in for asthma recently? Outcome? How long did your process take?
 
Monica,

The standard is are you fit to reasonably perform the duties expected of someone in your grade and AFSC.

It is possible that you will be found fit, but based on what you wrote about your condition that seems unlikely. Unless your condition is now under control or has gotten better. But if it has not, given that you are Security Forces, it seems likely that your asthma is unfitting.
 
monicat said:
Im getting a little nervous. I know each case is unique, but I found something on here stating they don't always base it off of the ablity to do the job you are rated on. Does this mean, I could be found fit?
I just wish I knew what my chances are of getting out. I feel like I'm in some kind of lottery. Has anyone else been in for asthma recently? Outcome? How long did your process take?
Click to expand...


Monicat,

I am also AF and I went through the MEB/IPEB process last summer for asthma and problems with my legs. I have similar FEV1 numbers to yours but mine are even a little worse. I don't have my PFT results with me but I think I was a 55 pre and 74 after treatment. I use my inhaler several times a day, Advair 500/50 twice a day, and singular once a day. My asthma still kicks my butt. When they sent my package to the IPEB I was sure I'd be med separated or retired. However they returned me to duty. I was happy because I wanted to stay in but surprised that they let me stay in. It turns out that the letter my commander provided to the med board said I was fully WW qualified and that I can do all aspects of my job and have no problems with PT. I am fully able to do my job (desk job) but the only time I've been able to get above a 75 on the PT test is when I've been exempt from the run. Also although technically it is up to the commander if I deploy or not, my pulmonary doctor already told me he would step in if they try to deploy me. I had enough problems when I was in Korea that he wouldn't want to take a chance of me going somewhere that would make my conditions worse.

Since I've been returned to duty by the IPEB, I've been diagnosed with severe sleep apnea and have to use a CPAP machine at night. The CPAP machine has helped me tremendously with my alertness during the day and my energy level is great. However, because I use CPAP I am being med boarded again and will probably start the process again after the holidays. I am kind of like you and although I have 14 years in, I'm tired of this situation and hope they med retire me. I went from being a good high school cross country runner to my current state of having to use an inhaler before I struggle to run half a mile without stopping because I am wheezing so bad.

As far as how long the process took - I was officially diagnosed with Asthma in May of 2007. My package was sent to the MEB mid June and they forwarded my case to the IPEB a week later. They then kicked it back after two weeks because it was missing a signature. I then received the decision from the IPEB on 8 Aug. So probably about 8 weeks total from the time of the MEB till I received my results.

Chris
 
I appreciate your info, Chris2000! I really hope they don't keep me in. Luckily my commander specifically said in his letter that I am no longer capable of doing my primary duties. I'm hoping this will have a huge impact!
 
I was wondering what your NARSUM said? Did you make it known that you wanted to saty in, or did you want to get out?
I just had my sleep study last night and I have to go back to get another, this time WITH the cpap. This delayed the process for at least another 2 weeks. Its a little stressful!
How are you in your process?
I hope you get what you want out of it. I know its hard after 14 years, but I wish you the best!
 
monicat said:
I was wondering what your NARSUM said? Did you make it known that you wanted to saty in, or did you want to get out?
I just had my sleep study last night and I have to go back to get another, this time WITH the cpap. This delayed the process for at least another 2 weeks. Its a little stressful!
How are you in your process?
I hope you get what you want out of it. I know its hard after 14 years, but I wish you the best!
Click to expand...

I did not provide any type of written statement to my first IPEB but when I go through this time I sure will. I don't want any confusion about what my conditions are and what I am capable of. If they return me to duty they need to know that they are returning somebody to duty who isn't 100%. I'm even thinking about sending copies of the dozens of profiles I've been on over the last 4 years to the board. The narative summaries that my 2 doctors provided in my previous MEB/IPEB for my leg problems and asthma made it clear that I had serious health issues but both of the doctors knew I wanted to stay in so they didn't go over the top with how much it impacted me. My commander who didn't want to lose me wrote in her required letter to the IPEB that I was great and fully capable of passing my PT test and she felt I was fully WW qualified. I'm great at my job but I couldn't run 1.5 miles right now if my life depended on it.

I think I should be starting the MEB/IPEB process again in January but I'm not totally sure. The sleep doctor I had my follow up with a month ago wasn't exactly great. I asked him several times when he would be starting me in the MEB process and he finally snapped "why are you so worried about it, they always return everyone to duty for sleep apnea." I've heard of people with sleep apnea who use CPAP that fall through the cracks and never get sent through the MEB/IPEB process.

The whole process is very stressful. Good luck and I hope it goes smoothly for you.

Chris
 
Hello!
I'm Monicat, but for some reason, I couldn't log into that account anymore! Soo, here I am.
An update on mine. My paperwork was sent to MEB and they referred me to IPEB. The only thing that has changed, in my favor is that I am now on the nebulizer daily and was issued a cpap, in addition to all of the medication I was already on.
I also had a problem with my commanders narrative.
He had written his letter at the beginning of the process. I was on a waiver but it was the generic waiver simply saying I was unable to deploy. This is what he used in his narrative. "Member is able to perform all in garrison duties with the exception of deployment." My profile has changed since then. My Dr. even put on the new profile that he didn't want me to arm up (I'm an SF troop), no strenuous activity causing me to become short of breath and no PT. When I asked him about changing his letter to reflect it, he flipped out and said he had tried helping me out by writing the letter and now I was saying it wasn't good enough. ????
Well, last week I had my last appt with my Dr and PEBLO before they submitted the paperwork and they noticed his letter had gone over the 90 day mark, so he had to re-write it and add the additional findings. He flipped out again and thought I had put them up to it?? He only changed the date and sent it in like that. Sigh. So, my Dr. narrative says it impacts my duties, my superintendent wrote a letter and said the same, it effects my duties and career progression and so did another person I work with. My question is, is this going to affect the outcome? All 3 of the other people say it seriously impedes my progression and duties except for his.

My paperwork was sent to AFPC either yesterday or this morning. What the latest time line been? Also, I've been reading that some people had received emails and a website link stating their paperwork was received? Is this everyone?

Thank you guys for all of your help!!
 
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