RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01818
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air Force Reserve O3, Maintenance Officer, medically separated for “rheumatoid arthritis” with a disability rating of 20%.

CI CONTENTION:  The CI requests the panel review the disability rating awarded by the Physical Evaluation Board.  The CI’s 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 - 20040628	VARD - 20050302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rheumatoid Arthritis	5002	20%	Rheumatoid Arthritis	5002	60%	20041216	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:  

Rheumatoid Arthritis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s arthritis was first documented on 6 November  2003, when she presented to the medical clinic with a 2-week history of progressively worsening pain and swelling in her wrists, fingers, elbows, knees and ankles bilaterally.  She also complained of overwhelming fatigue and spinal stiffness.  The CI was evaluated by rheumatology, diagnosed with rheumatoid arthritis, and started on medication (Humira).  December 2003 the CI was profiled for work limitation to 8 hours per day.  

The MEB NARSUM examination on 18 May 2004, 6 months prior to separation, noted complaints of joint stiffness, pain and fatigue.  The examiner noted that in February 2004 the joint symptoms and fatigue resulted in a profile limiting her work day to no more than 4 hours and that she presented on 8 March 2004 with “such profound fatigue that she required a total of 72 hours of quarters to recover.”  Physical examination showed tenderness in the cervical and lumbar spine with the range of motion (ROM) limited to 80% due to stiffness and pain.  The CI’s wrist were swollen and tender, without erythema, and limited in flexion and extension due to stiffness and pain.  The joints of the middle, index fingers and thumb were boggy, tender and fusiform bilaterally.  The ankle and calcaneus were swollen, tender and mildly erythematous bilaterally.  All major and minor joints showed limitation in ROM due to stiffness and pain.  

A rheumatology evaluation dated July 2004 noted an acute “major league flare-up.”  The examiner noted that the CI was unable to make a fist and almost total body and joint involvement.”  The flare-up was supported by laboratory findings of elevated C-reactive protein (a maker for acute inflammation) which was previously normal.  The CI was started on methotrexate (immunosuppressant) and prednisone (oral steroids) for her acute exacerbation.  

At a rheumatology examination performed on 11 August 2004, the CI complained of pain and swelling in the joints.  She also reported dry eyes (ocular sicca symptoms), dry mouth and mild exertional shortness of breath (dyspnea).  The physical examination was normal.  At the MEB examination (recorded on DD Form 2697) dated October 2004, 3 months prior to separation, the CI reported rheumatoid arthritis and was taking Humira, Prednisone and Methotrexate.  

At the 16 December 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported taking Humira 40 mg subcutaneously every 2 weeks, Methotrexate every week, Prednisone daily and a Folic acid tablet daily for her condition.  The CI reaffirmed the gradually progressive worsening pain she was experiencing.  She stated that she had ongoing daily symptoms of fatigue, lack of endurance, discomfort and stiffness to all joints.  Her fingers were worse than her hands, worse than her wrists and worse than her elbows.  She had ongoing stiffness of her toes, ankles and knees.  Physical examination showed very dry and mildly red eyes, swelling of the digits of both hands, and quick fatigability in hand grip bilaterally.  There was decreased range of motion in shoulders, wrists, ankles, and hips, bilaterally.  The examiner opined that the CI had active rheumatoid arthritis that was not stabilized.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the arthritis 20%, coded 5002 (arthritis rheumatoid (atrophic)), citing DoD and VASRD guidelines.  The VA separately rated left foot and ankle at 10% , left knee at 10%, left hand and wrist at 10%, left shoulder at 10%, right foot and ankle at 10% , right knee at 10%, right hand and wrist at 10%, right shoulder at 10%, for a combined rating of 60%, coded 5002 (Arthritis rheumatoid (atrophic)), based on the C&P examination, citing limited motion of a major joint or group of minor joints.  

The panel noted three episodes of incapacitating exacerbations over a 12-month period prior to separation (November 2003, March 2004, and July 2004) and fatigue and multi-joint pain resulting in an inability to perform military duties and activities of daily living.  Panel members agreed that the evidence supports a 40% rating for symptoms productive of definitive impairment of health and incapacitating exacerbations occurring 3 or more times in a year.  The evidence did not support a rating for totally incapacitating rheumatoid arthritis or severely incapacitating episodes occurring 4 or more times per year or over a prolonged period of time.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 40% for the rheumatoid arthritis, coded 5002.  

BOARD FINDINGS:  In the matter of the rheumatoid arthritis, the panel unanimously recommends a disability rating of 40% coded 5002 IAW VASRD §4.71a.  There were 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	
Rheumatoid Arthritis	5002	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01818.

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 XXXXXXXXXXXXXXXXXXX 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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings