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AF | PDBR | CY2014 | PD-2014-02204
Original file (PD-2014-02204.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2014-02204
BRANCH OF SERVICE: Army  BOARD DATE: 20140820
SEPARATION DATE: 20070129


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-2 (42L/Administrative Specialist) medically separated for an autoimmune hepatitis condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent P3 profile, which allowed for an alternate aerobic event to satisfy physical fitness standards and was referred for a Medical Evaluation Board (MEB). The autoimmune hepatitis condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Additionally, osteopenia, secondary to steroid prescription was also submitted by the MEB as medically acceptable. The Informal PEB adjudicated “autoimmune hepatitis” as unfitting, rated 20%, citing criteria of the VA Schedule for Rating Disabilities (VASRD). The osteopenia condition was determined to be not unfitting by the PEB. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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. The requested osteopenia secondary to steroid prescription which was determined to be not unfitting by the PEB is likewise 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 20061229
 VA - (1.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Autoimmune Hepatitis 7345 20% Autoimmune Hepatitis 7345 20% 20070306
Osteopenia secondary to steroid prescription Not Unfitting Osteomalacia Associated with Autoimmune Hepatitis 5014 10% 20070306
Other x 0 (Not in Scope)
 Other x 0 20070306
Rating: 20%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20070306 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Autoimmune Hepatitis Condition (AIH). The first abnormal liver function tests were from 3 February 2005 while deployed in Iraq. He was diagnosed with acute hepatitis and medically evacuated from theater on 21 February 2005. At that time, he had nausea without vomiting, no abdominal pain, 5-pound weight loss, night sweats, fatigue, malaise and yellow sclera of the eyes. An ultrasound of the abdomen on 23 February 2005 revealed normal liver, gallbladder, kidneys and pancreas. He had a liver biopsy on 15 March 2005 with a final diagnosis of autoimmune hepatitis on 7 April 2005.

The narrative summary prepared on 18 September 2006, 4 months prior to separation, notes the CI was evacuated from Iraq for nausea, jaundice and hepatitis. He underwent a liver biopsy and was diagnosed with autoimmune hepatitis. He was treated with Prednisone and 6-Mercaptopurine. The AIH condition was never brought into full remission. In July 2006, he was referred to Walter Reed Army Medical Center. At the time, his symptoms included weight loss of 10 pounds, fatigue and occasional nausea. A repeat liver biopsy showed significant amount of progressive liver damage. Medications were increased, resulting in improvement with decreased fatigue and nausea, but not complete remission. The examiner opined the CI would require life-long therapy and may develop cirrhosis, which would normally require an evaluation of liver transplantation. Physical examination showed no icterus, a soft non-tender abdomen and no liver or spleen enlargement. Weight was 182 pounds (MEPS entry physical on 5 February 2004 was 192 pounds). At the VA Compensation and Pension exam performed on 6 March 2007, 2 months after separation, the CI reported that by September of 2006 his liver function tests finally began trending down and his intermittent nausea subsided and he began to put on weight. He still had ongoing problems with fatigue. He no longer had right lower quadrant or flank pain, or nausea, which characterized his illness since it began in February 2005. There were side effects from his medications of depressed mood and acne.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD code 7345 (chronic liver disease without cirrhosis) which includes autoimmune hepatitis used by both the PEB and the VA for a 20% rating. The Board did not find evidence of an enlarged liver (hepatomegaly) or incapacitating episodes during the past 12 months for a higher rating of 40%. There were no alternate or additional VASRD codes for a higher rating. 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 autoimmune hepatitis condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that osteopenia was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Osteopenia, secondary to steroid prescription: On 7 February 2008, the CI had a bone density scan which revealed a normal examination. The interpreting physician reported that while the CI was in the “normal” range, he was so close to the osteopenic range for the lumbar spine and distal radius, he should continue with the diagnosis of osteopenia. The examiner documented that based on age, gender and ethnic matched controls, the range would be just into the osteopenia range for the lumbar spine and just out of the osteopenia range for the distal radius. The VARD found no evidence of functional impairment related to the osteomalacia (osteopenia) condition. The condition was not profiled. The Board did not find evidence of any impairment due to the bone condition that could otherwise indicate unfitness, such as pathological fractures, any need for prolonged hospitalizations, or prolonged absence from duty. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the osteopenia condition and so no additional disability ratings are recommended.


BOARD FINDINGS: 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 condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended osteopenia condition, the Board unanimously recommends no change from the PEB determination of not unfitting. 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.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140509, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record










                                   
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX , AR20150006389 (PD201402204)

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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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