RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxx	CASE:  PD1300159
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130813
SEPARATION DATE:  20051018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (2T051/Traffic Management Journeyman) medically separated for systemic lupus erythematosus (SLE).  Her illness began in November 2004 when she experienced postpartum cardiomyopathy.  In March 2005, she was evaluated for symptoms consistent with SLE, including arthritis/arthralgias in multiple joints, malar rash, pleuritic chest pain and anemia.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The SLE condition, characterized as “Systemic lupus erythematosus with multiple organ involvement: hypertension, lupus nephritis (Class II), tenosynovitis, subcutaneous nodules, malar rash, arthralgias and anemia” and “Post partum cardiomyopathy NYHA Class I,” were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB adjudicated “Systemic Lupus Erythematosus with Class II Nephritis and Stage I Chronic Kidney Disease, asymptomatic with normal renal function studies” as unfitting, rated 10%, referencing the Department of Defense Instruction (DoDI) 1332.39 and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions (post-partum cardiomyopathy and hypertension) were determined to be Category II, which can be unfitting, but are currently not compensable or ratable.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “I feel that the rating for the conditions which rendered me unfit should be changed because my health has continued to decline since I was released from the military.  My military doctor, Dr. B--, told me (not in these exact words) that my illness (lupus) is not going to get better, only worse and for that release the military was not going to allow me to continue my service.  So I feel that, if my disabilities are that risky to the point where the military finds me unfit to perform my military duties, then the military should find me fit to be medically retire, at the least.  My military career is over and I will never again have the opportunity to attempt to complete at least 20 years of service and retire as a regular service member would.  I had to accept the fact that I would be released newly married with a newborn, declining health and unemployed in a matter of 7 months from the date I was diagnosed to the date I signed my discharge papers and surrendered my military ID.  Soon after I separated, I tried to join the Army Reserves and was turned down because of my separation code.  The recruiter told me that, unless my disabilities no longer exist, then I couldn't join any branch.  I wasn't ready to leave the military.  I honestly wanted to retire or at least complete my first period of service and reenlist for another period of service.  I've even tried to convince my husband to go on active duty just so I could be in that military environment once more.  I now work with a lot of retired military people and find myself wondering how my life would of been if I only had the opportunity to stay in longer.  Military diversity was such a wonderful experience.”

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.  The post partum cardiomyopathy, hypertension, and any remaining conditions rated by the Department of Veterans Affairs (DVA) at separation are not within the Board’s purview.  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 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 DVA, operating under a different set of laws.  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 20050830	VA - (10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
SLE w/ Class II Nephritis and Stage I Chronic Kidney Disease	6350	10%	Lupus Nephritis	7541	30%	20060821	
Postpartum Cardiomyopathy	CAT II	Cardiomyopathy	7020	0%	20060821	
Hypertension	CAT II	No VA Entry	
No Additional MEB/PEB Entries	Other x 1	20060821	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20061017 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Systemic Lupus Erythematosus (SLE) Condition.  The CI developed hypertension and preeclampsia during her second trimester of pregnancy in 2004.  Twelve days after delivery in November 2004, she developed congestive cardiac failure due to post partum cardiomyopathy.  After several months her symptoms improved with treatment and subsequent echocardiograms showed improving heart function.  In March 2005 the CI developed signs and symptoms consistent with SLE that included arthritis and arthralgias in multiple joints, rash, pleuritic chest pain, anemia, and fatigue.  Laboratory testing revealed results consistent with the diagnosis.  In May 2005, she developed lupus kidney disease verified by subsequent kidney biopsy in July 2005.  She responded well to medication such that by the time of the 22 June 2005 rheumatology MEB narrative summary, and 7 July 2005 nephrology consult she was asymptomatic and the physical examinations were normal except for elevated blood pressure.  A 26 July 2005 nephrology follow-up noted the type of lupus nephritis shown on biopsy did not require specific therapy at that time.  The physical examination was normal.  At a follow up rheumatology appointment at the time of separation from service in October 2005, the CI was asymptomatic and physical examination was normal, including blood pressure.  The rheumatologist concluded the CI was in clinical remission.  Laboratory testing obtained at that time was noted for normal kidney function and a normal level of urine protein excretion.  At a VA nephrology visit, 6 months after separation, kidney function was normal with no evidence of recurrence of nephritis.  At the VA Compensation and Pension examination on 21 August 2006, performed 10 months after separation, the CI remained asymptomatic.  She was employed and loaded trucks for UPS.  The physical examination was normal including blood pressure.  There was no evidence of skin lesions, cardiac signs, swelling or arthritis.  The doctor reported the postpartum cardiomyopathy, lupus, lupus nephritis, and lupus related arthropathy were in remission.  Echocardiogram performed on 21 August 2006 demonstrated normal cardiac function.  VA treatment records indicate the CI did well until March 2007, 2 years after separation, when she experienced a flare of her lupus and lupus nephritis.  She responded well to medication treatment with resolution of symptoms.
The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10% for exacerbations once or twice per year or symptomatic during the past 2 years and coded it 6350 for SLE with Class II nephritis and Stage I chronic kidney disease.  The VA rated the condition 30% for albumin constant or recurring with hyaline and granular casts or red blood cells and coded it 7541 for lupus nephritis.  Following initial treatment for SLE beginning in June 2005, the CI had no further disease exacerbations until 2 years after separation.  All Board members agreed the 10% rating under VASRD diagnostic code 6350 was supported.  There was no evidence to support a higher rating under this code.  Although the VA adjudicated a 30% rating for lupus kidney disease, there was no active kidney disease at the time of separation or for 2 years after separation.  The Board therefore did not conclude there was evidence to support a rating under VASRD diagnostic code for lupus nephritis at the time of separation.  There were no other residuals of SLE up which to base consideration for other ratings.  The post partum cardiomyopathy was not attributed to SLE and demonstrated full recovery.  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 with Class II nephritis and Stage I chronic kidney disease, asymptomatic with normal renal function tests condition at the time of separation.

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 SLE with Class II nephritis and Stage I chronic kidney disease, asymptomatic with normal renal function tests 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	
Systemic Lupus Erythematosus with Class II Neprhitis, Asymptomatic with normal renal function tests	6350	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-00159.

	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,

Attachment:
Record of Proceedings