RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXXXX CASE: PD1200691 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130410 

DATE OF PLACEMENT ON TDRL: 20010512 

DATE OF PERMANENT SEPARATION: 20030330 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SPC/E-4 (74B/INFORMATION SYSTEMS 
OPERATOR/ANALYST), medically separated for systemic lupus erythematous (SLE). Symptoms 
which led up to this diagnosis first surfaced in 1999. Despite hospitalization and multiple 
medication regimens, the CI did not improve adequately with treatment to meet the physical 
requirements of her Military Occupational Specialty (MOS). She was issued a permanent 
P3/U3/L3 profile (for SLE associated arthritis) and referred for a Medical Evaluation Board 
(MEB). The SLE condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501; 
and, no other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated SLE 
as unfitting, rated 60%, citing criteria of the Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD); and, the CI was placed on the Temporary Disability Retired List (TDRL). After 25 
months on TDRL, the condition was considered to be stable but still unfitting. The IPEB at this 
time rated the condition at 10%, citing VASRD criteria. The CI appealed to FPEB, submitted 
additional information and waived her formal hearing. The President of the Washington PEB 
and the US Army Physical Disability Agency (USAPDA) reviewed the additional information and 
both affirmed the IPEB findings and recommendations. The CI was thus permanently separated 
with a 10% disability rating. 

 

 

CI CONTENTION: “My record stated that I did not miss any work at the time I was discharged. 
That statement was not accurate. I have been unable to perform many duties. At that time, 
constantly in pain and was experiencing flares that were treated with medication. I am still 
experiencing flares several times a year. My quality of life has decreased due to the pain and 
the side effects of the medication. This has led to depression and frequent anxiety attacks.” 

 

 

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 SLE condition is 
addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of 
the Board. Any conditions or contention not requested in this application, or otherwise outside 
the Board’s defined scope of review, remain eligible for future consideration by the Army Board 
for Correction of Military Records. The Board acknowledges the CI’s information regarding the 
significant impairment with which her service-connected condition continues to burden her; 
but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the 
authority to compensate members for anticipated future severity or potential complications of 
conditions resulting in medical separation. That role and authority is granted by Congress to 
the Department of Veterans Affairs (DVA), operating under a different set of laws. Post-
separation evidence is probative to the Board’s recommendations only to the extent that it 
reasonably reflects the disability at the time of separation. 

 

 

 


TDRL RATING COMPARISON: 

 

Final Service PEB - 20021105 

VA (12 months prior to separation) –Effective 20020311 

On TDRL - 20010512 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Condition 

TDRL 

Sep. 

SLE 

6350 

60% 

10% 

SLE 

6350 

60%* 

STR from 
20020311 to 
20021220 and 
Civilian records 
from 20030103 
to 20031215 

 

All others x 4/ Not Service Connected X 3 

 

Combined: 60% . 10% 

Combined: 80%** 



*SLE rated at 10% effective 20010512 18 months prior DOS and 4 months after placement on TDRL, VA exam 20010905 

**SLE decreased to 10% effective 20070901, VA exam 20070206 combined decreased to 60% 

 

 

ANALYSIS SUMMARY: N/A 

 

Systemic Lupus Erythematous Condition. In the Spring of 1999 the CI was hospitalized twice for 
acute, active manifestations that were consistent with SLE which was confirmed by high titer 
autoantibodies (+ANA, SS-A and SS-B). These symptoms included: bilateral knee pain with large 
effusions (swelling), chest pain with shortness of breath (from both a painful xyphoid and a left 
pleural effusion serositis), sore throat (from yeast infection), poor appetite, headaches, hair 
loss, back pain, diffuse arthralgias (joint pain) and fatigue (likely related to myositis/myalgias). 
She was started on a typical medication regime for lupus to include moderate doses of 
Prednisone, Plaquenil, and Methotrexate. Her sore throat resolved with yeast medications, her 
knee pain responded to diagnostic and therapeutic arthrocenteses (fluid removal) yet she 
continued to have chest pain, back pain, fatigue and diffuse arthralgias. A bone scan was 
obtained which was negative and a repeat chest X-ray in July 1999 revealed the resolution of 
her left pleural effusion. She thus underwent injections of the xyphoid which significantly 
reduced her chest pain discomfort. 

 

In June 1999 she was issued a permanent profile for the medical condition arthritis, 
inflammation of muscles which restricted her to half day limited duty, no field duty, no 
crawling, stooping, running, jumping, marching or standing for long periods, no unit physical 
training, and no physical fitness testing. The commander’s statement written also in June 1999 
corroborated her half duty day limitation and further documented that her profile did not 
hinder her technical competence in Computer Operations yet did significantly restrain her 
ability to physically perform the functions required by her MOS and required of all soldiers. 

 

In late October 1999 she became pregnant and was advised to discontinue her lupus 
medications. She had a flare of her disease in March 2000 requiring hospitalization and 
moderate doses of Prednisone for a week for symptoms of persistent severe pleuritic chest 
pain, dyspnea, myalgias, arthritis, and fever. In May 2000 she had another flare requiring 
hospitalization for 3 days. After her successful delivery in July 2000 she was restarted on 
plaquenil with continuation of a tapering dose of Prednisone. 

 

She had no additional flares up to the time of narrative summary (NARSUM) completed January 
2001. At this exam the CI reported continued fatigue, intermittent anterior chest wall pain, and 
arthralgias of the hands, knees and ankles, and the knee pain worsened with stair climbing or 
walking greater than 5 minutes. She reported taking plaquenil and a slow taper of Prednisone. 
The NARSUM exam demonstrated clear lungs, full range-of-motion (ROM) of the back with no 
tenderness, full ROM of all joints of the hand with tenderness over the proximal 
interphalangeal joints bilaterally with no synovitis, normal full ROM of the wrist, elbows, 


shoulders, hips, knees, ankles and feet without tenderness or synovitis and no tenderness of 
the anterior chest wall. Her skin exam revealed no lesions and neuromuscular exam in all 
extremities was normal with no tenderness of the upper or lower musculature. The examiner 
diagnosed SLE manifested by arthritis and arthralgias, serositis, anti-nuclear antibody, 
leukopenia and myositis with other associated symptoms to include fatigue, myalgias, and 
costochondritis. The examiner opined the prognosis was indeterminate and that course of the 
individual and the SLE disease was variable and unpredictable, with many individuals 
experiencing a waxing and waning course of disease. She was referred to the PEB and 
subsequently placed on TDRL in May 2001. 

 

After the NARSUM, the service treatment record (STR) reflected continued low dose daily use 
of Prednisone in April 2001 and in August 2001 with an increase in the Methotrexate dose to 
help the stiffness in her hands and her anterior chest wall pain. No flares or hospitalizations 
were evident in this interval time frame. At the time of her VA exam completed September 
2001, 4 months after TDRL placement, the CI reported pain of her hands, wrists, ankles, and 
knees and low back pain, fatigue and stiffness with flare-ups. She was on a lower dose of 
Methotrexate and not taking Prednisone for her SLE and relied on heat, nonsteroidal anti-
inflammatories and narcotic based pain medication for her back pain. She reported working as 
a supply clerk and was walking and sometimes running two to three times per week. The VA 
exam demonstrated normal skin, lung, heart, and neuromuscular findings with a noted 5 of 5 
motor strength of her upper and lower extremities. Her gait and posture were normal and the 
lumbar spine had pain limited flexion at 75 degrees (90 normal) and painful extension 25 
degrees (25 normal). Her hand exam demonstrated a normal fist and grip strength bilaterally, 
feet exam revealed pes planus, bilateral hallux valgus yet normal non painful motion bilaterally. 
The exam was silent to specific ratable findings of the wrist, ankles and knees. 

 

The evidence was absent for STR until April 2002. At this time the CI sought treatment for 
anterior chest wall pain for which she was prescribed seven days of Prednisone. In December 
2002 the CI sought care in the emergency room for dyspnea and was given a Prednisone dose 
pack. There were no hospitalizations during this time interval. In January 2003 the evidence 
reflects a letter from her work coordinator which documented the CI was working as a 
computer operator, the CI’s work site had changed to accommodate her physical limitations 
due to her SLE condition, as it was less physically demanding. The coordinator additionally 
documented that this site did not require a full time PC technician yet she was allowed to work 
there to cover the building hours. 

 

At the TDRL exit exam completed September 2002 the CI reported intermittent episodes of 
pleuritic chest pain as well as hand and knee pain. The chest pain was relieved with changing 
positions or occasional use of Ibuprofen. The hand and knee pain would ease up by mid-
morning. She was taking Plaquenil and Methotrexate and had been off Prednisone for a 
month. The exam demonstrated specifically no swelling, tenderness, or warmth of any joint 
with full ROM. The examiner opined she had stabilized and documented she was working full 
time and had not missed work. 

 

The VA rating decision of March 2004 did not have a VA exam in evidence. The VA relied on 
STR from 11 March 2002 to 20 December 2002 and civilian records from 3 January 2003 to 
15 December 2003. The additional evidence after March 2003 reflected visits to the civilian 
Rheumatologist 4 times in 2003 resulting in prescriptions for Prednisone use and that the CI 
reported in December 2003 that she had decreased her work hours from full-time to part-time 
in April 2003. There was no documentation of hospitalizations for her flares or evidence of end 
organ disease. From September 2005 to November 2006 the SLE was quiescent and the VARD 
of June 2007 decreased the rating to 10% as there was no objective evidence of active disease 
on the March 2007 VA exam. While the CI was unemployed she had not filed the 
unemployability paperwork and therefore was denied this benefit by the VA. 


The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and VA chose the same coding options for the condition and both were subject to the same 
rating criteria IAW §4.88b—Schedule of ratings–infectious diseases, immune disorders and 
nutritional deficiencies. SLE, when acute, with frequent exacerbations, producing severe 
impairment of health, warrants a 100% rating. Where exacerbations lasting a week or more, 2 
or 3 times per year, are shown, a 60% rating is warranted. Where exacerbations occur once or 
twice a year or where SLE is symptomatic during the past 2 years, a 10% rating is warranted. 
Furthermore this condition can be evaluated either by combining the evaluations for residuals 
under the appropriate system, or by evaluating with DC 6350, whichever method results in a 
higher evaluation. The CI’s SLE is a systemic disability which required medication to control and 
is manifested with polyarthralgias (hands, knees, chest, and back), fatigue, and myalgias. 

 

The Board first agreed the evidence did not reflect severe impairment of health at the time of 
TDRL placement nor at the TDRL exit exam to warrant the 100% rating. The Board also agreed 
the rating at the time of TDRL placement is consistent with a 60% rating for an unstable 
condition that had resulted in hospitalizations twice in the year 2000 as well as a half day work 
schedule evidenced in the profile and commander’s statement. As for the permanent rating 
recommendation the Board notes the PEB assigned a 10% rating with evidence up to 
September 2002, yet the VA assigned a 60% citing in its decision citing that the medical 
evidence in March 2002 supported a worsening disease due to use of Prednisone, an altered 
employment site to accommodate her physical impairments 3 months prior to separation and 
finally due to decreased work hours as she accepted part-time employment as of April 2003, on 
month after separation. The Board agreed the full-time employment history at the time of 
separation reflects a rating consistent with the 10% rating and further agreed the part-time 
status was not established until after separation. Therefore, the Board engaged in a lengthy 
discussion if the use of Prednisone connotes worsening disease and or qualifies as regular 
exacerbations. The VASRD does not specifically define ‘exacerbations’ under this diagnostic 
code thus allowing the evaluator some level of interpretation of the evidence. The medical 
member reviewed VA case law and offers it does not implicate prednisone use as the sole 
criteria of an exacerbation. Therefore, during its deliberations the Board not only discussed 
Prednisone use but also considered functional impairment which was the two criteria 
considered with the VA’s rating decision. IAW VASRD §4.10 functional impairment states “The 
basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a 
system or organ of the body to function under the ordinary conditions of daily life including 
employment.” Members agreed while the CI sought care for worsening pain resulting in 
prescriptions for Prednisone, the evidence does not reflect these episodes resulting in 
hospitalizations nor loss of time from work. The medical member discussed that the evidence 
reflects the waxing and waning course of the individual or disease for this condition and 
intermittent use of Prednisone for pain is not unusual. The Board finally considered since the 
condition is stable if the residuals at the time of separation, rated separately, would provide for 
a higher rating. The evidence reflects subjective multiple painful joints with no objective 
ratable evidence for any of them. Therefore a higher rating could not be achieved with this 
approach. 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 SLE 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 SLE condition and IAW VASRD §4.88b, 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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

TDRL 

PERMANENT 

SLE 

6350 

60% 

10% 

COMBINED 

60% 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120611, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

Director of Operations 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxx) 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxx, AR20130009625 (PD201200691) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)