RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00115
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20020508

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Fireman, medically separated for “polyarthralgia,” with a disability rating of 20%.  

CI CONTENTION:  The CI requested consideration of 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 - 20020131	VARD - 20030319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Polyarthralgia	5299-5002	20%	Reiter’s Syndrome 	5099-5002	NSC	20030307	
Backache	Cat II	Low Back Strain	5292	20%	20030310	
No Evidence of Systemic, Rheumatic Disease	Cat II	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Polyarthralgia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s polyarthralgia (large joint pain) condition began in 2000 after a gradual onset of aching large joints and low back.  The CI underwent evaluations with rheumatology and was assessed with chronic arthralgia and no evidence of systemic rheumatic disease.  His condition was treated conservatively; however, due to continued pain, the CI’s condition did not allow for continued service, and he was referred to the MEB.

At the MEB examination dated 04 December 2001, 5 months prior to separation, the CI reported that his condition affected his back, knees and shoulder, with pain and swelling, and general inflammation.  The pain interfered with sleep and impacted his ability to jog or run

The MEB NARSUM examination on 29 November 2001, 6 months prior to separation, noted complaints of pain in his shoulder, back and knees that increased with minimal increase in physical exertion.  He had mild improvement with anti-inflammatory medications, but he was unable to tolerate treatment trials with disease modifying anti-rheumatic agents.  Physical examination demonstrated absence of active synovitis or limitation of range of motion (ROM) of peripheral joints, and a general normal examination.  There was tenderness to palpation of thoracolumbar junction. Laboratory evaluations were negative for any inflammatory process.  Both rheumatoid factor and test for Reiter’s disease was negative.  The examiner assessed polyarthralgia and backache, and noted there was no evidence of systemic rheumatic disease.

At the March 2003 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported he was currently not taking medication, but felt that he was unable to work because of his joint complaints.  Physical examination was unremarkable.  The examiner noted that the CI had no evidence of synovitis in his hands, wrists, elbows, shoulders, hips, knees or feet.  The ROM was “normal” in all joints.  There was only minimal tenderness in the soft tissue.  The rheumatologist opined that the CI “possibly” had an episode of Reiter’s disease while in the service, which consisted of a possible infection in the spring of 2000, followed during the summer of 2000 by bilateral knee swelling, ankle swelling, and plantar fasciitis.  This episode improved over several months, so that by the fall of 2001, he had no objective findings.  It was noted that evidence of any inflammatory process at this time was absent 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the polyarthralgia condition 20%, coded analogously 5099-5002(arthritis rheumatoid), The Navy PEB also listed “backache” and “no evidence of systemic, rheumatic disease” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the “backache” and “no evidence of systemic, rheumatic disease” were properly subsumed under the overall rating for the polyarthralgia IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA determined that the condition of Reiter’s Syndrome (polyarthralgia) was not service connected.

The Board agreed that a 20% rating under the 5002 code was justified for “One or two exacerbations a year in a well-established diagnosis” based on the 1 episode in 2000.  There was absence of evidence to support the higher level of 40% since objective evidence was not present.  All of the lab studies for an inflammatory condition were negative and evidence of incapacitating exacerbation occurring 3 or more times a year was not present.  There were no additional codes to consider that would lead to a higher rating.  The Board opined that the Category II conditions were integral components of the polyarthralgia pathology and could not be recommended for additional ratings IAW VASRD§ 4.14 (avoidance of pyramiding).  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 polyarthralgia condition.  

BOARD FINDINGS:  In the matter of the polyarthralgia condition and IAW VASRD §4.71a, the Board 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 20150123, 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 20 Oct 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX	     				  			  		  Assistant General Counsel
						  (Manpower & Reserve Affairs)