Search Decisions

Decision Text

AF | PDBR | CY2014 | PD 2014 01081
Original file (PD 2014 01081.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-01081
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141003
SEPARATION DATE: 20090827


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3P071/Security Forces Craftsman) medically separated for rheumatoid arthritis. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty. She was referred for a Medical Evaluation Board (MEB). The MEB forwarded the “rheumatoid arthritis” condition to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated the “rheumatoid arthritis” as unfitting, rated 20% citing criteria from the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “My rheumatoid arthritis has progressively gotten worse.”


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 rheumatoid arthritis condition is addressed below; 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 Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20090610
 VA - ( 4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Rheumatoid Arthritis 5002 20% BiLateral Hand and Wrist Rheumatoid Arthritis 5002 20% 20091209
Other x 0 (Not in Scope)
 Other x 4 (Not in Scope) 20091209
Combined: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20091229 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden her but emphasizes 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. Additionally, 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.

Rheumatoid Arthritis Condition. The CI developed pain and swelling of her wrists and finger joints in early 2008. Evaluation by rheumatology in June 2008 diagnosed rheumatoid arthritis involving her wrists and fingers (rheumatoid arthritis is a disease characterized by inflammation of the joints with swelling, pain and limitation of motion which can cause permanent joint damage if not successfully treated). The CI responded well to medication treatment with resolution of symptoms; however, her wrist and finger pain would recur with decreases in the dose of corticosteroid. A new anti-rheumatic medication was begun in January 2009. At the rheumatology evaluation on 24 February 2009, she was doing well and her joint examination was normal (without swelling, tenderness or limitation of motion of any joint). The MEB narrative summary dated 31 March 2009 reported the CI had responded well to treatment and had no symptoms or pain at that time. The CI had not missed any days of work. The physical examination was normal. In her statement on 9 April 2009, the CI stated the rheumatoid arthritis had only affected her hands and indicated that although she was currently stable, she anticipated symptoms would occur again in the future. The commander’s statement dated 10 April 2009 stated, “Currently her medication allows her to perform primary duties in the Security Forces career field without work-a-rounds.” However due to the risk for flares of her arthritis and limitations due to medications the commander recommended cross training out of security forces, or medical separation. A rheumatology follow-up examination on 27 August 2009, the day of the CI’s separation from military service, recorded some swelling and tenderness of the finger joints. The remaining joints were normal. At the VA Compensation and Pension examination on 14 December 2009, 3 months after separation, the CI was doing well. The examination of the joints was normal (no swelling, tenderness, limitation of motion or guarding of movement) and the examiner concluded there was no evidence of active rheumatoid arthritis at the time of the examination.

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and the VA rated the rheumatoid arthritis condition (coded 5002, rheumatoid arthritis) at 20%. At the time of separation, the CI’s rheumatoid arthritis was well controlled by medication, with minimal symptoms and objective findings. Her commander noted she was performing normal duties without work-a-rounds. In the year prior to separation, she experienced a mild exacerbation, but none after initiation of the new medication in January 2009. There were no incapacitating episodes and no definite impairment of health to support a rating higher than the 20% adjudicated by the PEB or VA. There were no chronic residuals such as limitation of motion or anklyosis of any joints to warrant consideration for rating joints separately. The Board noted that the VA granted separate joint ratings for chronic residuals in 2014, however, at the time of separation, there were no chronic residuals for rating consideration. 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 rheumatoid arthritis 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. In the matter of the rheumatoid arthritis condition and IAW VASRD §4.71a, 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 20140301, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record









                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01081.

         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,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01992

    Original file (PD-2013-01992.rtf) Auto-classification: Denied

    Review of the available service treatment record revealed that the CI first developed joint symptoms in April 2003.She presented in September 2003 with complaints of morning stiffness and pain and swelling of her hands wrists and shoulders. This was the approach taken by the VA, who assigned separate 10% ratings under a combination 6350-5002 code (5002 – rheumatoid arthritis) for each wrist and each hand (identified as right finger joints and left finger joints, or “group of minor joints”)....

  • AF | PDBR | CY2013 | PD-2013-01650

    Original file (PD-2013-01650.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The record indicated that the CI developed pain in the hands, wrists,knees, and feet with morning stiffness in December 2002. Exam documented bilateral wrist swelling and tenderness with painful ROM to VA normal limits.

  • AF | PDBR | CY2011 | PD2011-01046

    Original file (PD2011-01046.docx) Auto-classification: Denied

    The MEB forwarded rheumatoid arthritis to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. The PEB adjudicated the rheumatoid arthritis condition as unfitting, rated 20% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The examiner concluded: “Although she is capable of performing her duties within her MOS, she cannot participate sufficiently in field training and is non-deployable, her overall performance of duty as a soldier...

  • AF | PDBR | CY2011 | PD2011-00732

    Original file (PD2011-00732.docx) Auto-classification: Denied

    There was also swelling of the ankles noted. The Board noted that the VA subsequently rated the joints individually on the 23 November 2011 decision, over 4 years after separation and considered whether there were chronic residuals at the time of separation warranting rating separate from the arthritis condition. The Board considered the final rheumatologic examination, three months prior to separation, which documented excellent control of her RA with “no signs of active synovitis”, and...

  • AF | PDBR | CY2012 | PD 2012 01236

    Original file (PD 2012 01236.txt) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the RA condition as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The examiner noted swelling and tenderness of wrists as well as hands, knees, ankles, feet, and decreased strength testing, (2/5) due to extremely painful joint movement. The PEB and VA both coded the RA as 5002 (arthritis rheumatoid) and rated it 20% using the service treatment records (STRs).

  • AF | PDBR | CY2013 | PD-2013-02210

    Original file (PD-2013-02210.rtf) Auto-classification: Denied

    Bilateral Knee Pain Condition . The CI continued with left knee pain and was seen by physical therapy (PT) for an evaluation. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2011 | PD2011-01131

    Original file (PD2011-01131.pdf) Auto-classification: Denied

    The PEB adjudicated the rheumatoid arthritis condition as unfitting, rated 20% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The PEB and VA both rated the condition 20% under the same code, 5002, rheumatoid arthritis. The Board agreed that rheumatoid arthritis was rated by both the PEB and VA as a systemic condition code 5002 but, that IAW §4.71a, involved joints may be individually rated.

  • AF | PDBR | CY2009 | PD2009-00689

    Original file (PD2009-00689.docx) Auto-classification: Denied

    All evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s 20% rating decision for the rheumatoid arthritis condition. Service Treatment Record. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2013 | PD-2013-02624

    Original file (PD-2013-02624.rtf) Auto-classification: Denied

    The MEB also identified and forwarded two other conditions (rheumatoid arthritis and osteoarthritis) as failing retention standards.The Informal PEB adjudicated “chronic pain right knee due to medial meniscus tear”as unfitting, rated 10%,citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.The remaining conditions were determined to have existed prior to service (EPTS) and not permanently aggravated beyond natural progression by such service. The examiner noted the...

  • AF | PDBR | CY2011 | PD2011-00706

    Original file (PD2011-00706.docx) Auto-classification: Denied

    The PEB adjudicated the polyarthralgia condition with chronic knee, ankle, shoulder and hand pain as unfitting rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The rheumatology evaluations never recorded any complaint of shoulder pain, and joint examinations by the rheumatologist were normal. ROM examinations at the time of MEB and the VA C&P examination proximate to the time of separation support the 10% rating adjudicated by the PEB.