RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX  	CASE:  PD-2014-00380
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150610
SEPARATION DATE:  20050705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Food Services) medically separated for a kidney condition.  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 P4L2E2 profile and referred for a Medical Evaluation Board (MEB).  The “nephrotic range proteinuria” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “nephrotic range proteinuria” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB also adjudicated a sickle cell trait condition as Category III, a condition that is not separately unfitting and not compensable or ratable.  The CI appealed to the Formal PEB (FPEB), which affirmed the PEB findings, however, decreased the rating to 0%.  The CI appealed and the Secretary of the Air Force/Medical Review Board Panel (SAF/MRBP) affirmed the FPEB findings and rating, and the CI was medically separated.

CI CONTENTION:  The CI contended for a 30% disability rating.  His complete submission is at Exhibit A.

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 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:

FPEB – Dated 20050322	VA* - (~13 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Nephrotic Range Proteinuria	7502-7599	0%	Nephrotic Syndrome	7502	30%	20060801	
Other x MEB/PEB Conditions x 0 (Not In Scope)	Other x 7 	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20060817 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Nephrotic Range Proteinuria Condition.  On 7 June 2004 the CI was evaluated by a nephrologist for recently identified proteinuria (abnormal levels of protein in the urine).  Past medical history at that time was remarkable for hypertension that was well-controlled and intermittent lower extremity edema that resolved with elevation of the legs.  Examination showed a blood pressure of 102/58 and trace edema of the extremities.  Urine studies showed nephrotic range proteinuria (over 3-3.5 grams in 24 hours), but no urinary casts or red blood cells.  Radiographic imaging and kidney biopsy results were normal.  Blood tests of kidney function were normal.

At a follow-up exam on 26 July 2004 (11 months prior to separation) edema of the lower extremities was noted to be 1+ (mild).  Proteinuria was noted to be improved but still high.  The nephrologist recommended she be returned to duty with follow-up every six months.  A clinical entry on 15 November 2004 (8 months prior to separation) noted all recent blood pressures were normal.  Trace edema was present on exam.

In a clinical note written for the MEB by a nephrologist on 16 February 2005 (5 months prior to separation) the CI reported trace to mild edema.  Examination showed a blood pressure of 117/65 and trace edema.  A urine test did not report the presence of casts.  Clinical evaluations on 21 April and 15 June 2005 (a month prior to separation) noted the absence of edema.

At the VA Compensation and Pension exam performed 13 months after separation, the CI reported she was taking no medication for her kidney condition or hypertension.  Examination showed a blood pressure of 123/78 and no evidence of peripheral edema.  A urine test showed proteinuria; red blood cells or casts were not reported.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating analogously to 7502 (nephritis, chronic), while the VA rated the condition at 30% under the same code.  The Board agreed this was the best coding option, which relies on an assessment of renal dysfunction for rating.  Since the 60% rating criteria were not present (“Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101”), deliberation settled on the 0% vs 30% criteria, which are excerpted below:

Albumin constant or recurring with hyaline and granular casts or red 
	blood cells; or, transient or slight edema or hypertension 
at least 10 percent disabling under diagnostic code 7101………..30 

Albumin and casts with history of acute nephritis; or, hypertension 
	non-compensable under diagnostic code 7101……………..……………0

The presence of albumin (protein) in the urine is stipulated in both ratings.  However, the Board noted there was no evidence of hypertension sufficiently severe to warrant a 10% rating under the 7101 code or of recurring hyaline or granular casts or red blood cells in the urine.  A 30% rating was therefore not justified on this basis.  The Board also considered that trace to mild edema was variably noted by examiners, but that service exams proximal to separation and the VA exam 13 months after separation reported no edema.  The Board majority concluded that the 30% rating was not justified on this basis, and the clinical condition was therefore best depicted by the 0% rating criteria.  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 nephrotic range proteinuria 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.  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 nephrotic range proteinuria condition and IAW VASRD §4.115a, the Board by a majority vote 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 20140113, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXX 
XXXXXXXXXXXX 
XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00380.

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