RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01081
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141003
SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3P071/Security Forces Craftsman) medically separated for rheumatoid arthritis.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was referred for a Medical Evaluation Board (MEB).  The MEB forwarded the “rheumatoid arthritis” condition to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the “rheumatoid arthritis” as unfitting, rated 20% citing criteria from the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My rheumatoid arthritis has progressively gotten worse.”

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 rheumatoid arthritis condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 20090610	VA - ( 4 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rheumatoid Arthritis	5002	20%	BiLateral Hand and Wrist Rheumatoid Arthritis 	5002	20%	20091209	
Other x 0  (Not in Scope)	Other x 4 (Not in Scope)	20091209	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20091229 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden her but emphasizes 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 Department of Veterans Affairs, operating under a different set of laws.  Additionally, post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Rheumatoid Arthritis Condition.  The CI developed pain and swelling of her wrists and finger joints in early 2008.  Evaluation by rheumatology in June 2008 diagnosed rheumatoid arthritis involving her wrists and fingers (rheumatoid arthritis is a disease characterized by inflammation of the joints with swelling, pain and limitation of motion which can cause permanent joint damage if not successfully treated).  The CI responded well to medication treatment with resolution of symptoms; however, her wrist and finger pain would recur with decreases in the dose of corticosteroid.  A new anti-rheumatic medication was begun in January 2009.  At the rheumatology evaluation on 24 February 2009, she was doing well and her joint examination was normal (without swelling, tenderness or limitation of motion of any joint).  The MEB narrative summary dated 31 March 2009 reported the CI had responded well to treatment and had no symptoms or pain at that time.  The CI had not missed any days of work.  The physical examination was normal.  In her statement on 9 April 2009, the CI stated the rheumatoid arthritis had only affected her hands and indicated that although she was currently stable, she anticipated symptoms would occur again in the future.  The commander’s statement dated 10 April 2009 stated, “Currently her medication allows her to perform primary duties in the Security Forces career field without work-a-rounds.”  However due to the risk for flares of her arthritis and limitations due to medications the commander recommended cross training out of security forces, or medical separation.  A rheumatology follow-up examination on 27 August 2009, the day of the CI’s separation from military service, recorded some swelling and tenderness of the finger joints.  The remaining joints were normal.  At the VA Compensation and Pension examination on 14 December 2009, 3 months after separation, the CI was doing well.  The examination of the joints was normal (no swelling, tenderness, limitation of motion or guarding of movement) and the examiner concluded there was no evidence of active rheumatoid arthritis at the time of the examination.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the rheumatoid arthritis condition (coded 5002, rheumatoid arthritis) at 20%.  At the time of separation, the CI’s rheumatoid arthritis was well controlled by medication, with minimal symptoms and objective findings.  Her commander noted she was performing normal duties without work-a-rounds.  In the year prior to separation, she experienced a mild exacerbation, but none after initiation of the new medication in January 2009.  There were no incapacitating episodes and no definite impairment of health to support a rating higher than the 20% adjudicated by the PEB or VA.  There were no chronic residuals such as limitation of motion or anklyosis of any joints to warrant consideration for rating joints separately.  The Board noted that the VA granted separate joint ratings for chronic residuals in 2014, however, at the time of separation, there were no chronic residuals for rating consideration.  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 rheumatoid arthritis 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 rheumatoid arthritis condition and IAW VASRD §4.71a, 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 20140301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01081.

	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