RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03047
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080922

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

CI CONTENTION:  “Please 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 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 – 20080528	VARD – 20081015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Systemic Lupus Erythematosus	6350	10%	Systemic Lupus Erythematosus	6350	10%	20080801	
Hypothyroidism	CAT III	Hashimoto’s Thyroiditis	7903	10%	20080801	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Systemic Lupus Erythematosus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s joint pain began in April 2007.  The CI was referred to a rheumatologist who confirmed the diagnosis of systemic lupus erythematosus (SLE) in November 2007.  The MEB forwarded “systemic lupus erythematosus” for PEB adjudication.  At the 25 March 2008 Internal Medicine evaluation, performed 6 months before separation, the CI reported occasional joint pains and popping of her knees and wrists.  Overall, her symptoms were well controlled with medication.  The MEB NARSUM examination on 17 April 2008, 5 months prior to separation, noted complaints of intermittent joint pains, especially in the hands and knees, and fatigue.  Physical examination revealed no joint limitation, no effusion, and full range of motion.  At the 1 July 2008 Rheumatology evaluation, performed 3 months before separation, the CI reported continued intermittent back, arms, and legs pain. She also reported fatigue and lack of energy.  Physical examination showed tenderness to palpation of shoulder, elbow, wrists, hands, hip, knees, and ankle joints. There was no swelling, decreased range of motion, instability, crepitus, warmth, and erythema.  She was diagnosed with Lupus Erythematosus-Systemic, Fibromyalgia, and Arthralgia-Multiple Sites.  At the 1 August 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported symptoms of pain in joints and fatigue.  She reported that her lupus was in remission, but when active, symptoms were daily and lasted for 7 days.  She also reported that she was currently in remission.  The examiner also noted a history of Raynaud's-like symptoms and paresthesia.  Physical examination showed her skin clear of rashes and lesions.  The vascular examination was within normal limits.  Range of motion of the right and left shoulder, elbow, wrist, hip, knee, and ankle joints all was normal, but there was pain limited motion with repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the systemic lupus erythematosus condition 10%, coded 6350 (lupus erythematosus, systemic).  The VA also rated the systemic lupus erythematosus condition 10% coded 6350, based on the VA C&P examination 2 months before separation, citing exacerbations once or twice a year, or a conditions which was symptomatic (with symptoms of fatigue) during the past 2 years.  The Board first considered whether a higher rating under code 6350 was justified.  For a 60% rating the CI must have SLE exacerbations lasting a week or more, 2 or 3 times per year.  The CI was initially evaluated and diagnosed with SLE in November 2007.  By March of 2008 she was taking Plaquenil with good control of her symptoms with occasional joint pains.  Per the STR there were no further records indicating a significant exacerbation.  The C&P examination did mention having daily symptoms but she also stated she was in remission.  Therefore the Board concluded that there was no evidence of SLE exacerbations lasting a week or more, 2 or 3 times per year justifying a rating of 60%.  The Board also considered the possibility of rating for residuals of SLE.  There was no evidence of kidney (7541), skin (7809 or 7811), vascular, thromboembolic, gastrointestinal, cardiac, or pulmonary involvement.  The CI was also diagnosed by the rheumatologist with both Raynaud’s syndrome and fibromyalgia.  The CI had a several year history Raynaud’s syndrome (7117) which is a symptom of both SLE and/or fibromyalgia but did not have the characteristic attacks occurring one to three times a week to justify a 10% rating.  Though fibromyalgia occurs at a higher incidence rate among those with SLE it is not a direct symptom and therefore could not be rated.  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 systemic lupus erythematosus condition.  

Contended PEB Conditions:  Unspecified Hypothyroidism.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended hypothyroid condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards and the CI had been cleared to deploy.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the systemic lupus erythematosus condition and IAW VASRD §4.88b, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypothyroidism condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20151215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 14 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN