RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00274
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Armament Systems Journeyman, medically separated for “recurrent, non-obstructing nephrolithiasis” rated 0%.

CI CONTENTION:  The CI indicates he continues to suffer from kidney stones and back pain, and has undergone surgery on his kidneys and back.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20060405	VARD - 20021124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent…Nephrolithiasis	7508	0%	Nephrolithiasis	7508	30%	20060824	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Recurrent, Non-Obstructing Nephrolithiasis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s nephrolithiasis condition began in May 2004 when he presented with flank pain and hematuria (blood in the urine).  In July 2005 the CI underwent an ureteroscopy for a blocked ureter and ureteral stent placement.  From July 2005 to March 2006 the CI had 7 emergency department visits for pain (colic), nausea, and vomiting secondary to kidney stones.  The CI was treated with supportive measures for the passage of kidney stones which included intravenous (IV) fluids and antiemetic, intramuscular pain medication, urinary tract specific (pyridium) pain medication, and IV narcotic pain medication.  Dietary therapy included recommendations for increased hydration (2-3 quarts per day), limitation of animal proteins to 10 ounces per day, and avoidance of grapefruit and apple juice.  A CT scan in January 2006 demonstrated 5 kidney stones in the right kidney.

The 27 February 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of episodic flank pain with the passing of kidney stones.  The examiner noted episodes for flank pain, hematuria, and stone passage; three in (May, June, and August) 2004, five in 2005, and one in 2006.  The CI was treated symptomatically with dietary modification, pain medications, and antibiotics.  Physical examination was normal.  At the 24 August 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant 6-7/10 abdominal pain with weekly blood in his urine.  The abdominal examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the recurrent nephrolithiasis condition 0%, coded 7508 (nephrolithiasis).  The VA rated the nephrolithiasis condition 30%, coded 7508, based on the C&P examination 2 months after separation, citing evidence of invasive or noninvasive procedures more than two times per year, diet therapy, or drug therapy and frequent attacks of colic with infection (pyonephrosis) and impaired kidney function.  The treatment record evidenced recurrent kidney stones requiring surgical intervention in 2005, diet therapy, and multiple episodes of pain medication and hydration management for stone passage in 2004, 2005 and 2006.  The panel majority agreed that the evidence supports a rating of 30% under VASRD 7508 for recurrent stones formation requiring diet therapy, drug therapy, or invasive or non-invasive procedures more than two times per year.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the nephrolithiasis condition, coded 7508.

BOARD FINDINGS:  In the matter of the recurrent nephrolithiasis condition, the panel majority recommends a disability rating of 30%, coded 7508 IAW VASRD §4.115b.  The single voter for dissent recommends no change and submitted the appended minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Recurrent, Non-obstructing Nephrolithiasis	7508	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150420, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MINORITY OPINION:

The minority dissent with the majority recommendation was based on the totality of the evidence in the STR for the recurrent, non-obstructing nephrolithiasis condition.  The PEB correctly rated the condition at 0% based on VASRD rating for nephrolithiasis:  there was no diet therapy, no drug therapy, and there was no invasive or non-invasive procedures of more than two times a year.

The minority member asserts that the CI did not meet any of the three criterion for a higher rating under the nephrolithiasis code 7508.  There was no STR evidence that the CI was prescribed a specific diet or was confined to any rigid dietary restrictions, and several preventative medicine notes did pursue the option for dietary counseling.  The majority support for this criterion rested on the CI’s receipt of generic discharge instructions for kidney stones; e.g., hydration, avoidance of acidic juices, heavy protein loads, etc.  There was no evidence verifying compliance with even these general measures, and the NARSUM did not mention diet.  The minority member asserts that it is not reasonable to concede the latter as satisfying the 7508 criterion of “diet therapy.”

Likewise, there was no drug therapy prescribed to the CI to treat kidney stones.  Although there are specific drugs used to treat kidney stones, the CI was not prescribed any of them, and only received pain medications.  The NARSUM, in fact, entered “none” for current medications.  The minority member asserts that it is not reasonable to concede routine pain management as satisfying the 7508 criterion of “drug therapy.”

The only “invasive or non-invasive procedure” in evidence was the endoscopic stent placement in July 2005 (10 months before separation).  Although the CI required several emergency department (ED) visits for recurrent kidney stones, he only received routine treatment with intravenous hydration and pain medications.  The minority member asserts that it is not reasonable to concede these routine ED interventions as “procedures,” and, the single stent procedure does not satisfy the 7508 stipulation of “more than two times/year” for a 30% rating.

The totality of the evidence provided ample support for a conclusion that the PEB’s adjudication of the nephrolithiasis condition was reasonable and fair, and consistent with the VA rating decision.

The Secretary is respectfully requested to consider the minority recommendation that there be no modification or re-characterization of the CI’s service disability determination.

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00274.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings