RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02208
BRANCH OF SERVICE:  Army	DATE REMOVED FROM TDRL:  20061106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “chronic glomerulonephritis with nephropathy” with a disability rating of 0%.

CI CONTENTION:  There are still symptoms that were the reason for separation.  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 – 20040817/20061025	VARD - 20070419	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Chronic Glomerulonephritis with Nephropathy	7502	30%	0%	Immunoglobulin M (IGM) Nephropathy	7536	No VA Claim	0%	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Glomerulonephritis with Nephropathy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s edema condition began in December 2003.  The MEB forwarded “IGM nephropathy (autoimmune disease of kidney filters)” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 28 June 2004, 6 months prior to TDRL placement, the CI reported edema (swelling) of both legs that had progressed to his entire body.  Physical examination showed pitting edema to the lower extremities.  The examiner noted that the CI, while stationed in Iraq, had anasarca (whole body edema) with laboratory findings of proteinuria (protein in the urine) with microscopic hematuria (blood in the urine) suggestive of chronic glomerulonephritis (inflammation of the kidney).  The MEB NARSUM examination on December 2003, 8 months prior to TDRL placement, noted complaints of edema.  Physical examination showed trace moderate (2+) pretibial pitting (skin indents under pressure and the indent slowly returns to normal) edema.  Correlative laboratory findings showed large amounts of protein in the urine (3+) with a blood urea nitrogen 12 mg/dl and creatinine 7 mg/dl (laboratory tests for kidney function).  Renal biopsy further supported the diagnosis of IgM nephropathy manifesting as a nephrotic syndrome (kidney disease where there is a large amount of protein in the urine, low albumin in the blood, and swelling of the extremities).

At the TDRL evaluation performed on 01 August 2006, the CI was noted to have undergone therapy with Cytoxan (immunosuppressant) and steroids with resultant remission of his condition.  Physical examination demonstrated no pitting edema.  Laboratory findings were consistent in demonstrating stabilization of the CI’s condition (Glomerular filtration with urine protein, urine creatinine and protein/creatinine).  At a nephrologist examination in 16 October 2006, there was no evidence of lower extremity edema, urine protein, and creatinine ratio.  The CI was removed from TDRL on 22 November 2006.  There was not any TDRL removal examination.  The CI filed his original VA disability claim on 21 December 2006; however, he failed to report for a scheduled VA Compensation and Pension (C&P) evaluation on 5 March 2007.

The Board directed attention to its rating recommendation based on the above evidence.  At TDRL placement, the PEB rated the chronic glomerulonephritis with nephropathy condition 30%, coded 7502 nephritis, chronic, citing constant proteinuria (symptom of kidney disease), the condition has not stabilized.  At TDRL removal, the PEB rated the chronic glomerulonephritis with nephropathy condition 0%, coded 7502 nephritis, chronic, citing the condition is considered sufficiently stable for final adjudication, and utilized a nephrologist note dated 16 October 2006 as a basis for their decision.  The VA rated the chronic glomerulonephritis with nephropathy condition 0% coded 7356 (glomerulonephritis), citing that the CI failed to report for a VA C&P examination, 4 months after TDRL removal; and that no current medical evidence was available to consider a higher evaluation.  The Board noted that nephrology evaluation, 1 month prior to TDRL removal, noted the CI and examiner reported he was in complete remission.  The examiner noted there was no lower extremity edema.  The August 2006 urine sample demonstrated normal protein/creatinine ratio levels.  Board members agreed that the evidence did not support a higher than 0% rating.  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 adjudications for the chronic glomerulonephritis with nephropathy condition at TDRL removal.

BOARD FINDINGS:  In the matter of the chronic glomerulonephritis with nephropathy condition and IAW VASRD §4.115b the Board unanimously recommends no change in the assigned rating at TDRL removal.  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 20150704, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005400 , XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure