RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-02310
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20030720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E4, Electric Power Production Apprentice, medically separated for “HIV associated syndrome,” with a disability rating of 10%.  

CI CONTENTION:  The applicant contends a gout condition.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB - 20030429	VARD - 20040406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
HIV Associated Syndrome	6351	10%	HIV Related Illness	6351	0%	20040315	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Human Immunodeficiency Virus (HIV).  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a positive HIV test during pre-deployment screening in February 2003 (5 months prior to separation).  There was no preceding history of HIV conversion or of common risk factors for transmission.  There was no history of HIV-related symptoms or opportunistic infections/complications, depression, or memory loss in the available outpatient STR or NARSUM; although, the CI was treated for shingles during the MEB period.  A T4 cell count was 535 (marker for HIV which destroys healthy T4 immune cells and lowers the count, normal 500-1500) and an HIV viral load was 10,499 (normal is undetectable).  No treatment was indicated by 2003 guidelines.  The NARSUM was conducted 31 March 2003 (4 months prior to separation) and verified the above facts.  No mental health symptoms, history, or diagnosis were referenced.  The physical examination was normal except for a resolving shingles rash, and there was no adenopathy.  Cognitive testing was not documented.  An addendum on 2 April documented a repeat T4 count of 525 and viral load of 21,736.  

The earliest VA Compensation and Pension examination is from 9 November 2010 (over 6 years after separation) and thus not temporally probative to the Board’s recommendation.  The post-separation VA rating decision (VARD) referenced a VA outpatient examination from 15 March 2004 (8 months after separation) which is not in evidence; but, the VARD documented the absence of any HIV-related symptoms, complications or physical findings.

The Board directed attention to its rating recommendation based on the above evidence.  The VASRD §4.88b criteria (unchanged from 2003) for a 0% rating under code 6351 (HIV-related illness) are “Asymptomatic, following initial diagnosis of HIV infection, with or without lymphadenopathy or decreased T4 cell count”; and, those for 10% are, “Following development of definite medical symptoms, T4 cell of 200 or more and less than 500, and on approved medication(s), or; with evidence of depression or memory loss with employment limitations.”  Higher ratings require specific opportunistic infections or other complications of HIV.  Although the rationale for the PEB’s 10% rating was not elucidated, members agreed that no criteria for a higher rating were in evidence.  The VA’s initial 0% rating, based on Service evidence, specified the absence of each 10% criterion.  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 of the HIV condition.

BOARD FINDINGS:  In the matter of the HIV condition and IAW VASRD §4.88b, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
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-2014-02310.

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