RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201576
BRANCH OF SERVICE:  Army	BOARD DATE:  20130731
DATE OF PLACEMENT ON TDRL:  19990708
Date of Permanent SEPARATION:  20021114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (71L/Administration) medically separated for a chronic liver condition.  In March 1998, she was diagnosed with autoimmune hepatitis and was treated with medication.  However, given the nature of the liver condition, she could not fully meet the duty requirements of her Military Occupational Specialty (MOS).  She was issued a permanent P3 profile and underwent a Medical Evaluation Board (MEB).  The liver condition, characterized as “autoimmune hepatitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also forwarded three other conditions (see rating chart below) for PEB adjudication.  The PEB found the hepatitis condition unfitting.  The other three conditions were determined to be not unfitting.  The CI was placed on the Temporary Disability Retired List (TDRL) with a rating of 30%.  Approximately 16 months later, a reevaluation was performed and the TDRL status was extended.  Then on 3 September 2002, the PEB found the unfitting hepatitis condition sufficiently stable for permanent adjudication.  A disability rating of 0% was assigned.  The CI did not accept the PEB findings and requested a formal hearing.  She later withdrew that request.  The PEB findings were affirmed by the US Army Physical Disability Agency (USAPDA), and the CI was medically separated.

CI’s CONTENTION:  “Because the condition is not stable and can flare at times for an undetermined amount of time.  There is not a cure or specified medication to cure, medications prescribed has caused other side effects.”

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 autoimmune hepatitis condition is addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Final Service PEB - 20020903	VA (2 mo. Prior to Adjudication Date*) - Effective 19990709	
On TDRL - 19990709	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Autoimmune Hepatitis	7399-7345	30%	0%	Autoimmune Hepatitis	7345	30%	19990907	
Bilateral Bunionectomies	Not Unfitting 	Hallux Valgus, Left	5280	10%	19990907	
		Hallux Valgus, Right	5280	10%	19990907	
Migraine Headaches	Not Unfitting	No VA Entry	
Adjustment Disorder	Administrative Channels		
No Additional MEB/PEB Entries.	Other x 0		
Combined:  30% → 0%	Combined: 50%	
*Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation.
ANALYSIS SUMMARY: 

Autoimmune Hepatitis (AIH).  In March 1998, the CI was evaluated by gastroenterology and was diagnosed with AIH.  She was treated with medication, and her liver condition improved.  However, she was not able to fully meet the duty requirements of her MOS, so an MEB was initiated.  The narrative summary was dictated on 24 March 1999.  At that time, the CI reported intermittent fatigue, dizziness, and weakness.  Physical exam (PE) of the abdomen was normal.  There was no tenderness, guarding, rebound, or hepatosplenomegaly.  Laboratory testing revealed that her liver associated enzymes were completely normal.  An Army PEB was convened in April 1999.  The CI was placed on the TDRL with a disability rating of 30%.  The Board considered all the evidence, and determined that a higher rating at that time was not warranted.  IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD), a 40% rating would require “Daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly” or “incapacitating episodes having a total duration of at least four weeks, but less than six weeks, during the past 12 month period.”  Since the treatment record did not show sufficient evidence of these findings, the Board has no basis to recommend a rating higher than 30%, at the time of initial placement on TDRL.

On 7 September 1999, 2 months after starting TDRL, the CI had a VA Compensation and Pension exam.  She was having intermittent pain in the right upper quadrant, with occasional nausea and vomiting.  The symptoms did not limit her ability to perform normal daily activities.  PE of the abdomen was normal, and laboratory testing showed normal liver function tests.  On 28 May 2002, after 34 months of TDRL, the CI was reevaluated at Eisenhower Army Medical Center.  At that time, the CI denied any significant abdominal discomfort, nausea, vomiting, diarrhea, unintentional weight loss, arthralgia’s, fevers, or fatigue.  PE was normal.  Laboratory testing revealed that her liver associated enzymes (aspartate aminotransferase & alanine aminotransferase) were completely normal.  On 13 November 2002, the CI had a follow up visit, and was doing very well.  She was taking an immunosuppressive drug called Purinethol (6 mercaptopurine or 6 MP).  She denied any fatigue, abdominal pain, nausea, or vomiting.  PE was normal at that time.  The examiner was considering stopping the 6 MP medications, to see how she would do without it.  On 14 November 2002, the CI was removed from TDRL and permanently separated from the Army with a disability rating of 0%.

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation based on the above evidence.  As noted above, the September 2002 Army PEB rated the CI’s chronic liver condition at 0%.  The PEB concluded that she was nonsymptomatic at that time.  For the reader’s convenience, the VASRD §4.114 language for diagnostic code 7345 (Chronic liver disease without cirrhosis) is excerpted below:

Daily fatigue, malaise, and anorexia, with minor weight loss and  
hepatomegaly, or; incapacitating episodes (with symptoms such as  
fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right
upper quadrant pain) having a total duration of at least four weeks,
but less than six weeks, during the past 12 month period....................................40 

Daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly),  
requiring dietary restriction or continuous medication, or; 
incapacitating episodes (with symptoms such as fatigue, malaise, 
nausea, vomiting, anorexia, arthralgia, and right upper quadrant 
pain) having a total duration of at least two weeks, but less than four
weeks, during the past 12 month period...............................................................20 

Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes 
(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, 
arthralgia, and right upper quadrant pain) having a total duration of at 
least one week, but less than two weeks, during the past 12 month period.....................................................................................................................10 

Nonsymptomatic......................................................................................................0

After a thorough review of the treatment record, the Board determined that at the time of final separation from military service, the CI was not having any significant symptoms related to her chronic liver condition.  The AIH was in remission.  Therefore, she does not reach the minimum compensable rating level (10%) for diagnostic code 7345.  The Board tried to find a path to a rating higher than 0%, by trying to find other VASRD codes that could be applied to the CI’s chronic liver condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the AIH 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 autoimmune hepatitis (AIH) condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Autoimmune Hepatitis	7345	30%	0%	
COMBINED 	30%	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120730, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130018154 (PD201201576)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA