RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00089
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150127
SEPARATION DATE:  20041227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Aircraft Maintenance Craftsman), medically separated for a prostate inflammatory condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The prostate inflammatory condition, characterized as “chronic prostatitis and prostatodynia with interstitial cystitis,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “prostatodynia associated with chronic prostatitis and interstitial cystitis” as unfitting, rated 10%, with application of the Department of Defense (DoD) and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeal and was medically separated.

CI CONTENTION:  “After serving in the Air Force, I was determined unfit for duty.  It was determined that I had several problems that hindered me from doing my job.  I was relieved of duty from the Air Force in Dec of 2004 after being on a MEB for 2 years.  After getting out I fought with the VA for years before they gave me a disability rating.  My condition leaves me in pain everyday and I’m tired of dealing with the nonsense.  If you all find me to be an exception for a higher rating, I would greatly appreciate it.  10 years of faithful service with zero negative remarks and nothing to show for it.” [sic]

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  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 Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20041014	VA - 4 MOs Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Prostatodynia Associated with Chronic Prostatitis and Interstitial Cystitis	7527	10%	Prostatodynia with Prostatitis/Interstitial Cystitis with Urinary Frequency and Bladder Neck Hypertrophy	7599-7527	40%	20050418	
Other x 0 (Not in Scope)	Other x 0 (Not in Scope)	20050418	
Combined:  10%	Combined:  0%*	
VA rating derived from VA Decision Review Officer Decision dated 20050929, with Correction of Clear and Unmistakable Error dated 20060216.

ANALYSIS SUMMARY:

Prostatodynia Associated With Chronic Prostatitis And Interstitial Cystitis Condition.  Review of the service treatment record (STR) indicated that the CI developed flank pain in November 2002 followed by the development of pelvic pain associated with urinary urgency, frequency and painful ejaculation.  Evaluation by urology specialists concluded with diagnosis of chronic prostatitis (non-infectious) and interstitial cystitis (non-infectious).  Pain symptoms prevented an overseas assignment and performance of duties on the flight-line as an aircraft maintenance craftsman and he was assigned to administrative duties.  Despite medication treatment and nerve injections by a pain specialist the CI did not experience a significant improvement in symptoms.  The pain management consultant on 18 September 2003 recorded a night-time urinary frequency (nocturia) of four times per night.  At the urology appointment on 18 December 2003, the CI reported stated that he had nocturia 2 times per night and a 2-hour voiding interval during the day.  Subsequent treatment records noted continued urinary frequency but the main complaint was that of continued discomfort and pain limiting activities.  Despite the condition, the enlisted performance report for the period 7 May 2003 to 6 May 2004 documented excellent duty performance in administrative duties earning top marks and a promote ahead of peers recommendation.

At the narrative summary exam on 17 September 2004, 3 months prior to separation, the CI’s major complaints were excruciating chronic pain in the low back and rectum, dysuria (burning with urination), and tenesmus (a distressing but ineffectual urge to evacuate the rectum or urinary bladder).  There was no mention of nocturia or urinary frequency.  At the VA Compensation and Pension (C&P) exam on 18 April 2005, 4 months after separation, the CI reported that during the day he urinated 20 times at intervals of 30 minutes and during the night he urinated 9 times at intervals of an hour.  He had problems starting urination and the urine flow was weak, hesitant, with decreased force and burning, and painful.  He did not have any incontinence.  He also complained of weakness, fatigue, loss of appetite, weight loss, and limitation of exertion, renal colic, and painful intercourse.  Examination of the abdomen, prostate, and genitalia was normal.  The urinalysis was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition with code 7527 (Prostate gland injuries, infections, hypertrophy, post-operative residuals) at 10%, without any discussion.  The VA rated the condition (prostatodynia with prostatitis, interstitial cystitis with urinary frequency and bladder neck hypertrophy) at 40% based on the CI’s report of urinary frequency at the time of the post separation VA C&P examination.  The VASRD diagnostic codes for rating prostate conditions including prostatitis (7527) and interstitial cystitis (7512) direct rating based on the formula for voiding dysfunction (7512 and 7527) or urinary tract infection (7527), whichever is predominant.  Although the CI was initially treated with antibiotics, his condition was determined to be non-infectious and antibiotic treatment was stopped.  The Board concluded that urinary tract infection was not the predominant manifestation and that a rating higher than 10% is not supported under the formula for urinary tract infection.  A single rating applies for the related diagnoses of chronic prostatitis and interstitial cystitis since they are rated based on the same disability (urinary frequency).  Prior to separation, the urinary frequency was documented as a daytime voiding interval of 2 hours and night-time frequency of 2-4 times.  The daytime frequency supports a 10% rating while the upper end of nocturia supports a 20% rating.  The Board discussed the dramatically worsened urinary frequency pattern reported by the CI at the time of the post-separation VA C&P examination.  The Board noted that the symptom was relatively stable prior to separation and was not the dominant focus of clinical attention prior to separation.  Further, the Board noted the excellent duty performance in administrative duties as documented by the performance report noted previously.  The urinary frequency and impairment described at the time of the post separation VA C&P examination was not consistent with the STRs or the evidence of occupational performance prior to separation.  Therefore the Board placed greater weight on the evidence of the STRs.  All Board members agreed a 20% rating was supported with application of reasonable doubt (§4.3).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the prostatodynia associated with chronic prostatitis and interstitial cystitis condition (7599-7527).

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 prostatodynia associated with chronic prostatitis and interstitial cystitis condition, the Board unanimously recommends a disability rating of 20%, coded 7599-7527 IAW VASRD §4.115b.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Prostatodynia Associated with Chronic Prostatitis and Interstitial Cystitis	7599-7527	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		

SAF/MRB

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00089.

	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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

			Sincerely,

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR