RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02378
BRANCH OF SERVICE:  Army                                                             SEPARATION DATE:  20091111	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “Hepatitis C” with a disability rating of 10%.

CI CONTENTION:  The CI requests the board to consider all conditions.  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 - Dated 20090804	VARD - 20100601	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hepatitis C	7354	10%	Hepatitis C	7354	0%	20100309	
Attention Deficit Hyperactivity Disorder	Not Compensable	Attention Deficit Disorder	9499-9410	NSC	20100309	
Depression with Anxiety	Not Unfitting	Anxiety Disorder, NOS (Also Claimed as Insomnia and Depression)	9413	30%	20100309	
Left Shoulder Tendonitis	Not Unfitting	Left Shoulder Strain	5099-5019	10%	20100309	
Chronic Mid-Back Pain	Not Unfitting	MidBack Condition	5299-5237	NSC	20100309	
Gastro Intestinal Reflux Disease	Not Unfitting	Gastro Intestinal Reflux Disease	7399-7346	0%	20100309	
Chronic Bilateral Foot Pain 	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Hepatitis C.  Service treatment records (STR) indicate the CI was diagnosed with Hepatitis C after a routine blood donation in March 2007.  Gastroenterology placed him on interferon treatment in July 2007.  He completed treatment and was a partial responder with a continued viral load.  Examination of the abdomen in November 2008, showed normal bowel sounds, soft abdomen without guarding or rigidity, no mass and no enlargement of the liver or the spleen.  The commander’s statement noted the CI performed well on a day-to-day basis, that he was a good soldier, and that his profile did not limit his performance.  It was his medical condition as a whole with constant evaluations, treatments, re-evaluations and boards that affected his performance.  The narrative summary (NARSUM) in May 2009, noted the CI was asymptomatic.  The CI noted intermittent right upper quadrant abdominal discomfort that occurred every 3 to 4 days.  It was described as soreness and tenderness and occasional throbbing pain that lasted from an hour to an entire day.  Pain could reach 5/10 with no aggravating symptoms.  This was his abdominal state for past 5 months.  An abdominal examination on 6 April 2009, showed normal bowel sounds in all four quadrants, no tenderness to palpation, and no guarding rebound or rigidity.  

At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported no complaints related to the Hepatitis C condition and the abdominal examination was unremarkable.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 7354 (Hepatitis C).  The VA assigned a 0% rating using the same code.  The Board considered if a rating higher than 10% was warranted at the time of separation.  The 10% rating required intermittent malaise or incapacitating episodes while the higher 20% rating would require daily malaise or incapacitating episodes.  The CI noted he experienced abdominal discomfort no more than every 3 or 4 days with no other aggravating symptoms.  The Board agreed the 10% rating more accurately reflected the CI’s status.  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 Hepatitis C condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the attention deficit hyperactivity disorder (ADHD), depression with anxiety, left shoulder tendonitis, chronic mid-back pain, gastrointestinal reflux disease (GERD), and chronic bilateral foot pain conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

ADHD.  The CI had a childhood history of ADHD.  He resumed treatment with a stimulant medication with good results. 

Depression with Anxiety.  The CI reported to Behavioral Health in November 2011, that he had taken medication for depression for 3 days and shortly thereafter felt dizzy.  He was prescribed the medicine due to increased irritability, for which he claimed a lifetime history.  He reported being in many fights while growing up as a necessary part of life in his neighborhood.  The irritability was under control in the military until he began treatment for hepatitis.  Two weeks prior to the visit he admitted he had “head-butted” his wife who did not call police.  He reported frequent arguments with her, insomnia, sleep disturbance for several years and a lifetime of anxiety and hypervigilance.  He reported symptoms improved with medication.  The CI attended approximately nine follow up visits between 2007 and 2008.  He returned for follow up in May 2009, requesting a refill of medication stating his anxiety was increasing.  There were no further documented visits.

Left Shoulder Tendonitis.  The CI reported pain, weakness, stiffness and fatigue of the left shoulder from a fall.  The NARSUM examination showed decreased flexion with pain on extremes and no redness, swelling or bruising or instability.  The C&P examination noted he required no assistive devises, there were no effects on his usual occupation (he was not employed) and that he could perform routine daily activities, although painful.  He had full flexion of the shoulder and there was no limitation of motion with repetition.  

Chronic Mid-Back Pain. The NARSUM examination revealed slight midback tenderness in the bilateral paravertebral musculature with no step-offs, deviation, redness, swelling, spasm or bruising.  

GERD.  The CI had gastroesophageal reflux treated by medication since 2006.  The STR records from April 2008, noted the CI was stable on medication.

Chronic Bilateral Foot Pain.  The NARSUM examination of the feet showed full active range of motion (ROM) and no redness, swelling or bruising.  There was tenderness at the left hallux.  He was unable to heel or toe walk with the left foot due to pain at the left hallux.  Ankle motion was normal with no instability or weakness.  There were no abnormalities of the feet.  The C&P examination showed normal gait, 5/5 strength in all muscle groups, good pulses, painful motion of the ankles but no abnormalities.

The ADHD, depression with anxiety, left shoulder tendonitis, chronic mid-back pain, GERD, and chronic bilateral foot pain conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the Hepatitis C condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended ADHD, depression with anxiety, left shoulder tendonitis, chronic mid-back pain, GERD, and chronic bilateral foot pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140521, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160007112 (PD201402378)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure
CF:
( ) DoD PDBR
( ) DVA