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AF | PDBR | CY2013 | PD-2013-02163
Original file (PD-2013-02163.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02163
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141031
SEPARATION DATE: 20080811


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty TSgt/E-6 (1N373A/Slavic Crypto Linguist Craftsman, Russian) medically separated for interstitial nephritis. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a P4 profile, placed on limited duty and referred for a Medical Evaluation Board (MEB). The nephritis condition, characterized as chronic tubulointerstitial nephritis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated interstitial nephritis requiring chronic steroid treatment, recent creatinine normal as unfitting, rated 0%, referencing the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: There is a discrepancy between the VA rating & military rating. Not all conditions were considered in the military retirement process. Original rating was based on one condition which was the lowest rated issue. There were & still are multiple medical conditions to include Von Willibrands, hematuria, post cholecystectomy syndrome, erosive esophagitis, GERD, hiatal hernia, colitis, incomplete Right bundle branch block & undifferentiated arthropathy & HLA-B-27.


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 interstitial nephritis condition is addressed below. The requested Von Willibrands, post cholecystectomy syndrome, erosive esophagitis, gastroesophageal reflux disease, hiatal hernia, colitis, incomplete Right bundle branch block and undifferentiated arthropathy conditions were not identified by the PEB and are not 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 Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20080617
VA - (3 1/2 Mos. Post-Separation)
Condition
Code Rating Condition Code Rating Exam
Interstitial Nephritis Requiring Chronic Steroid Treatment 7502 0% Chronic Tubulointerstitial Nephritis as well as Lt Kidney Stone 7508-7537 0% 20081201
Other x 0 (Not in Scope)
Other x 3 20081201
Rating: 0%
Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 90615 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s sentiment regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System 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, operating under a different set of laws. The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. 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.

Interstitial Nephritis (Kidney) Condition. The narrative summary (NARSUM) notes the CI to develop bright red blood in his urine after a 12-mile run. Urology evaluation revealed a normal urine analysis (UA), a normal bladder and an abdominal CT scan showing normal kidneys, but a small inconsequential renal stone in the upper left kidney. In February 2007, a needle biopsy of the kidney for diagnosis was inadequate for analysis. A repeat needle biopsy performed on 17 April 2007, revealed chronic active inflammation of the kidney (interstitial nephritis). An extensive medical work-up revealed no infective allergic, toxic or immune etiology for the disease. The CI was treated with long-term oral steroid medication. (Prednisone 60 mg a day tapered to low dose 5 mg a day). From this time until separation, multiple laboratory tests of kidney function (creatinine, GFR, creatinine clearance albumin) and blood pressure measurements were normal. Analysis of the UA showed intermittent red blood cells, (related to exercise), but no signs of renal failure (albumin, protein or casts). Hematocrit and hemoglobin blood levels were always normal. Multiple measurements of blood pressure were normal. At the NARSUM evaluation performed on 27 March 2008, 5 months prior to separation, the CI reported general fatigue and continued intermittent blood in his urine after exercise. Current medication was only Prednisone 5 mg daily. Physical examination revealed a healthy appearing male in no distress. Blood pressure was normal. The remainder of the exam was normal with no clinical findings of kidney failure. Laboratory tests of kidney function were normal. Red blood cells were reported to be present in the UA, although not documented in the UA most proximate to this exam. At the VA Compensation and Pension exam performed 3 months after separation, the CI was noted to be well nourished, well developed and in no distress. The CI reported being a full time college student. Blood pressure measurements were normal on three readings. Physical exam was normal with no evidence of kidney failure. On laboratory evaluation, kidney function tests were normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the kidney condition 0% using different codes; the PEB, code 7502, (nephritis, chronic) and the VA, using a combination of two codes 7508-7537 (renal stone/interstitial nephritis). Codes 7502, IAW §4.115a and 7537, IAW §4.115b, are both rated under Renal Dysfunction. A 0% rating requires a UA with albumin and casts with a history of acute nephritis; or, hypertension not compensable under code 7101, (hypertensive heart disease), IAW §4.104. The next higher rating, under renal dysfunction, 30%, requires a UA with constant albumin and hyaline/granular casts or red blood cells; or transient or slight edema or hypertension at least 10% disabling under code 7101. Under code 7101, hypertensive heart disease, a 10% rating requires systolic blood pressures of 160 or more; or diastolic blood pressures of 100 or more; or need for continuous medication for control. No rating under this code is supported by the record in evidence as neither systolic nor diastolic hypertension is recorded. A 10% rating under code 7508 (nephrolithiasis) IAW §4.115b requires frequent attacks of colic, not supported by the record as the left kidney renal stone was small and asymptomatic. The Board agreed that no higher rating than 0% could be recommended under codes 7502, 7537 and 7101 or 7508 as the evidence in record documented normal kidney function, no clinical findings of kidney failure, no hypertension, no renal colic and intermittent, not constant, blood in the urine, related only to physical activity. The Board found no other appropriate codes for rating consideration. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously agreed that a disability rating of 0% for the kidney condition was appropriately adjudicated in this case.


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 kidney condition and IAW VASRD §4.115a, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131102, w/atchs
Exhib
it B. Service Treatment Record
Exhibit C. Department of Veterans
’ Affairs Treatment Record









                 
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review




SAF/MRB


Dear
XXXXXXXXXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02163.

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 appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,








XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

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