RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00888
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20090525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Material Management Craftsman) medically separated for an interstitial cystitis (bladder) condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS).  She was placed on duty and mobility restrictions and referred for a Medical Evaluation Board (MEB).  The “interstitial cystitis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “interstitial cystitis” as unfitting, rated 0%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (FPEB), which increased the rating to 20%.  The CI made no further appeals and was medically separated.  

CI CONTENTION:  “The applicant contends her interstitial cystitis condition rating at time of separation.  Her condition continues to worsen and negatively impact her daily activities.  Her 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 20090330	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Interstitial Cystitis	7512	20%	Interstitial Cystitis	7512	40%	20090928	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 35 	
RATING:  20%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20100428 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Interstitial Cystitis Condition.  The narrative summary (NARSUM) noted the CI had chronic pelvic pain since 2007.  Evaluations included unremarkable pelvic and abdominal ultrasounds and CT.  Gynecologic evaluation for pelvic pain including urinary frequency, urgency and stress incontinence included a diagnostic laparoscopy and cystoscopy.  Operative findings from 19 February 2008 were consistent with interstitial cystitis and hydro-distention of the bladder provided slight temporary relief.  Multiple medications (Pentosan, Amitriptyline, and Dicyclomine) were used to decrease urinary frequency and lower abdominal/bladder pain.  

At the MEB exam, performed 4 months before separation the CI reported continued urinary symptoms of frequency, urgency and pain with significant restrictions in activity.  The Urology evaluation from 22 September 2008, 9 months before separation, indicated continued urinary frequency, urgency and stress incontinence without the use of absorbent pads.  The NARSUM addendum dated 6 March 2009, three months before separation indicated continued daily symptoms and that the CI now needed to wear an absorptive pad during the day in case she had an episode of incontinence.  At the FPEB, two months before separation, the CI “testified her condition had not changed since September and although not prescribed, she wears absorbent pads which she changes no less than two times daily; that the frequency of change due to incontinence is dependent on her level of activity.”  

At the VA Compensation and Pension (C&P) exam performed four months after separation, the CI reported that had frequent daytime (17) and nighttime (3) urination.  She had urinary incontinence which required a pad as often as three times per day.  She did not require an appliance.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the FPEB (20%) and VA (40%) coded the CI’s condition using disability code 7512 (Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious), which is rated as a voiding dysfunction.  The CI did not require an appliance and the remaining rating criteria are based on “Requiring the wearing of absorbent materials (pads) which must be changed” either “more than 4 times per day” for 60%, “2 to 4 times per day” for 40% or “less than 2 times per day for 20%.”  Both the FPEB testimony for use of pads (“changes no less than 2 times daily”) and the VA C&P exam (“3 pad daily needed”) met the 40% rating criteria for “requiring the wearing of absorbent materials which must be changed 2 to 4 times per day.”  The CI did not require the use of an appliance or changing pads more than four times per day to warrant any higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the interstitial cystitis 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 interstitial cystitis condition, the Board unanimously recommends a disability rating of 40%, coded 7112 IAW VASRD §4.115a.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Interstitial Cystitis 	7512	40%	
RATING	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140220, 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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00888.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings

cc:
SAF/MRBR 
DFAS-IN