RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02312
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Ground Equipment Craftsman, medically separated for “seronegative rheumatoid arthritis” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 based upon a 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 - 20090520	VARD - 20091210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Seronegative Rheumatoid Arthritis	5002	20%	Seronegative Rheumatoid Arthritis	5002	20%	20091104	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Seronegative Rheumatoid Arthritis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s rheumatoid arthritis condition began in November 2007 with pain in the left foot absent any trauma.  The CI subsequently developed left wrist, thumb, and knee pain.  Diagnostic imaging was negative and in August 2008, rheumatology made the diagnosis of seronegative rheumatoid arthritis.  Despite treatment with systemic steroids, the CI had persistent pain in the feet, ankles, left knee and left wrist and was started on Humira (injectable adalimumab).  Symptoms were well controlled with Humira and the CI was able to decrease anti-inflammatory medication and increase low impact activities.  The MEB forwarded seronegative rheumatoid arthritis for PEB adjudication.  
The MEB NARSUM examination on 26 January 2009 described the course of the CI’s seronegative rheumatoid arthritis.  Physical examination showed normal gait and stance with normal movement of all extremities.  Left grip strength was decreased to 4/5 (5/5 normal) and there was slightly reduced biceps and thigh strength on left.  The NARSUM Addendum on 13 May 2009, 3 months prior to separation, noted the complaint of a diagnosis of rheumatoid arthritis and provided the above history.  The final diagnosis was “seronegative rheumatoid arthritis, improved on Humira.”  At a clinic visit on 12 May 2009, the CI reported that most of her pain was gone, and on a June 2009 visit the CI was pain free.  At the 4 November 2009 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported no current joint pain, swelling or redness.  She was taking Humira every 2 weeks with good effect.  Physical examination showed normal gait and full range of motion of all joints.  There was painful motion of each ankle and X-rays of all joints were negative.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the seronegative rheumatoid arthritis condition 20%, coded 5002 (Arthritis rheumatoid (atrophic) as an active process) citing activity restrictions and continued ability to perform in-garrison duties.  The VA also rated the rheumatoid arthritis condition 20% coded 5002 based on the VA C&P examination 2 months after separation, citing a history of rheumatoid arthritis with a positive exacerbation within the year.  There was no indication that any specific joint rose to the level of being unfitting, there were no non-joint symptoms of arthritis and the CI’s rheumatoid arthritis was well controlled.  There were no chronic residuals for alternative rating.  There was no evidence of symptom combinations productive of definite impairment of health objectively supported by examination findings, or incapacitating exacerbations occurring three or more times a year to support any rating higher than that awarded 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 seronegative rheumatoid arthritis condition.  

BOARD FINDINGS:  In the matter of the seronegative 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.  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 20140519, 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-2014-02312.

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