RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01055
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150513
Separation Date:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aerospace Maintenance Journeyman) medically separated for panuveitis.  The eye condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a duty limiting profile and referred for a Medical Evaluation Board (MEB).  The “panuveitis/Behcet disease” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “panuveitis, which may be a manifestation of Behcet’s disease” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB also adjudicated “recurrent oral ulcers” as a Category II condition that can be unfitting but is not currently compensable or ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI writes: “Behcet’s disease is incurable, I am required to receive treatment on a regular, and it impacts my daily life.”

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:

Service IPEB – Dated 20090302	VA* - (~6 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panuveitis, May Be Manifestation of Behcet’s Disease	6000	20%	Behcet’s Disease	6399-6354	10%	20081113	
Other x1 (Not in Scope)	Other x 4	20081110	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20090715 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Panuveitis.  The CI initially presented with symptoms of skin disease, lymphadenopathy, mouth ulcers and painful headaches in February 2008.  A few weeks later, he developed sensitivity to light and his provider noted symptoms of redness and pain in the right eye for 3 days with watery, itchiness, and photophobia.  The physical exam findings included decreased movement of the pupil and hyperemia of the conjunctiva.  The examiner diagnosed conjunctivitis and referred the CI immediately to the ophthalmologist.  The ophthalmologist also noted pain with eye movement and decreased vision.  He diagnosed right eye acute anterior uveitis and ordered lab tests and eye drops.  The examiner reevaluated the CI the next day and noted decreased tearing, pain and redness; he stopped the eye drops and directed a follow-up in 2 days.  Because the examiner was considering a diagnosis of sarcoidosis (inflammatory disease), a chest X-ray was done and found normal.  The next day, the examiner evaluated the CI and changed the diagnosis to anterior right eye uveitis.  The ophthalmologist followed the CI closely on a weekly basis and, on 17 March 2008, noted that the he had panuveitis of the right eye with photophobia, as the disease affected both the anterior and posterior chambers of the right eye.  The CI was started on a prednisone taper and different eye drops.  When he ran out of prednisone for one week, the ophthalmologist noted that the CI’s symptoms returned.  He was restarted on prednisone; however, a week later, he still had difficulty reading.  The ophthalmologist, based on the presentation of the eye disease, diagnosed Behcet’s disease and restarted a prednisone taper and Imuran (immunosuppressive drug).  The examiner noted an improvement in the CI’s vision and opined that the panuveitis was worse in the left eye than the right eye and that he still had difficulty reading.  The rheumatologist concurred that the diagnosis of Behcet’s was most likely, as a workup for an underlying etiology was negative.  

The VA Compensation and Pension (C&P) exam, approximately 6 months prior to separation, documented eye sensitivity and an active disease which caused functional impairment due to the CI’s inability to see correctly during a flare.  He was on a treatment regime that consisted of prednisone (corticosteroid), cyclosporine and azathioprine (both immunosuppressive drugs).  There were physical exam findings of left eye scleral injection (redness).  A second VA C&P exam done by an ophthalmologist 2 days later, documented symptoms of pain, distorted vision, redness, swelling, watering and blurred vision.  There were physical exam findings of normal bilateral intraocular pressure, uncorrected right far vision 20/70 and corrected right far vision 20/25; uncorrected left far vision 20/40 and corrected far left vision 20/20; both corneas with significant inflammatory deposits, the anterior chambers of both eyes had cells and flare; and an abnormal area between the iris and lens in the right eye.  

The MEB narrative summary (NARSUM) exam, approximately 5 months prior to separation, documented that the CI had recurrent panuveitis which required prednisone 40mg daily.  He was unable to perform routine, thorough inspections on the aircraft or wheels because his vision was constantly fluctuating.  The physical exam was deferred as he was followed closely by Ophthalmology and Rheumatology.  The commander’s statement documented that the CI’s medical condition had caused a significant decline in his capabilities and performance which caused unpredictable flare-ups that varied in severity and duration.  He further noted that the CI had episodes when his eyesight was very limited and restricted him from performing assigned computer or office duties.  His duty schedule was modified and he missed approximately five days in the prior 90 days due to his condition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the panuveitis condition as 6000 (choroidopathy, including uveitis, iritis, cyclitis, and choroiditis) and rated at 20%, consistent with “with incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months.”  The VA coded the Behcet’s Disease as 6399 analogous to 6354 (chronic fatigue syndrome) and rated at 10% for symptoms “which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication.”  There is ample evidence that the CI had recurrent panuveitis that responded poorly to a combination of medications.  The commander documented that the CI missed 5 days of work in the prior 90 days; however, there is no documentation that the CI actually had periods of incapacitation as defined by the VASRD.  Rating under code 6000 can also be based on the visual impairment due to the particular condition; however, the CI’s visual impairment documented in the evidence is non-compensable under VASRD §4.84a rating guidelines.  The Board by precedent will not revoke or lower a disability rating granted to a CI by the PEB.  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 panuveitis 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 panuveitis condition and IAW VASRD §4.75, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01055.

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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR