RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01009
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic liver disease without cirrhosis, hepatitis B” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20091017	VARD - 20100426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Liver Disease without Cirrhosis  (Hepatitis B)	7345	0%	Hepatitis B	7345	0%	20100312	
Allergic Rhinitis	Not Unfitting	No VA Placement	
Eustachian Tube Dysfunction	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Liver Disease without Cirrhosis (Hepatitis B).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hepatitis B was discovered in August 2007 during a routing blood donation.  Evaluation by hepatology in September and October 2008 and February 2009 documented no evidence of liver fibrosis on liver biopsy and no evidence of cirrhosis, ascites, or portal hypertension on liver ultrasound.  The CI had a high viral load with only intermittently elevated inflammatory markers (liver enzymes, and no evidence of liver dysfunction (normal bilirubin, glucose, and coagulation studies).  The CI was not a candidate for treatment.  

At the 19 August 2009 MEB NARSUM examination on, 3 months prior to separation, the CI denied nausea, vomiting, diarrhea, abdominal pain, bleeding, jaundice, and any new symptoms related to the viral infection.  The physical examination showed no evidence of liver disease to include yellowing of the skin or eyes (jaundice), enlarged lymph nodes (lymphadenopathy), enlarged liver or spleen (hepatosplenomegaly), or abdominal tenderness.  

At the 10 March 2010 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI denied fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain.  He had started medication (tenofovir) to treat the infection and denied any side effect from it.  The physical examination showed no evidence of liver disease, to include jaundice, icterus, hepatosplenomegaly, or abdominal tenderness.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the viral liver condition, coded 7345 (chronic liver disease without cirrhosis), citing no evidence of liver disease.  The VA also rated 0% for the viral liver condition, coded 7345, based on the VA C&P examination 4 months after separation, citing chronic liver disease without cirrhosis that is asymptomatic.  

There was no evidence of portal hypertension (hepatosplenomegaly, lab abnormalities), splenomegaly, weakness, anorexia, abdominal pain, malaise or incapacitating episodes for a higher rating under VASRD code 7312 (cirrhosis of the liver…) or 7345 (chronic liver disease without cirrhosis).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the viral liver condition.  

Contended PEB Conditions:  Allergic Rhinitis and Eustachian Tube Dysfunction.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither one of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the viral liver condition, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,