RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01054
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050607

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “benign essential tremor” with a disability rating of 0%.

CI CONTENTION:  The CI requested a review of 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 - 20050331	VARD - 20060724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Benign Essential Tremor…	8103-8199	0%	Benign Essential Tremor of Bilateral Hands	8199-8103	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Benign Essential Tremor.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s tremor condition began in approximately 2003, but worsened in 2004 when he first sought medical attention.  At the NARSUM examination on 11 January 2005 (5 months prior to separation) the CI reported that his hands were most affected by the tremors (left worse than right).  Although sometimes his forearms were involved, no other areas of his body were affected.  The tremors were constant and unaffected by motion or rest.  Physical examination showed a “slight hand tremor, only noticed when holding a piece of paper.”  The tremor was in both hands, and of equal apparent severity.  All other neurologic findings, including muscle strength, were normal.  At a follow-up on 29 March 2005 (2 months prior to separation), the CI reported that the tremor was improved on medication, and that he was “very happy” with the results.  Physical examination noted no obvious tremors.  An assessment on 14 April 2005 (2 months prior to separation) recorded that the benign tremor was “well controlled” with medication.  There was no VA examination in evidence within the 12-month allowable window for adjudication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using an 8103-8199 code, which likely represented an administrative error (i.e. it should be 8199-8103).  The VA also assigned a 0% rating, based on the STR, using the same coding pathway.  Under 8103 (tic, convulsive), a “mild” severity warrants a 0% rating, while “moderate” justifies the 10% rating.  Panel members agreed that the evidence is best described by the “mild” stipulation.  The next higher 10% rating therefore was not justified.  There were no other applicable coding options for this condition.  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 benign essential tremor condition.  

BOARD FINDINGS:  In the matter of the benign essential tremor condition and IAW VASRD §4.124a, 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01054.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings