RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02363
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20011022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “systemic lupus erythematous (SLE)” with a disability rating of 10%.

CI CONTENTION:  The CI referenced the VA rating decision.  The CI’s 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 - 20010823	VARD - 20020313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Systemic Lupus Erythematous	6350	10%	Systemic Lupus Erythematosus	6350	10%	20020205	
			Polyarthritis, Right Knee as Secondary to Systemic Lupus Erythematosus	5099-5003	10%	20020205	
			Polyarthritis, Right Elbow as Secondary to Systemic Lupus Erythematosus	5099-5003	10%	20020205	
			Polyarthritis, Bilateral Wrists as Secondary to Systemic Lupus Erythematosus	5099-5003	0%	20020205	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Systemic Lupus Erythematous.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s general medical condition became symptomatic in June 1997.  
Initially, the CI was diagnosed with inflammatory arthritis and in February 2000.  Rheumatology later definitively diagnosed her with lupus.  

Two separate clinical encounters dated 19 July and 20 October 2000 indicated the CI’s physical symptoms as occurring “intermittent.”  A single primary care encounter dated 21 February 2001 documented a “lupus exacerbation or flare-up.”  The MEB NARSUM examination on 3 July 2001, 4 months prior to separation, noted minimal complaints of systemic body systems excepting “…a little bit of left wrist and right elbow pain.”  Her physical examination (PE) was completely normal.  Her repeat laboratory work-up was normal.  The provider’s assessment documented the following:  [The CI] has done very well on (medication) therapy and is currently very well controlled with a minimum of symptoms.” 

At the 5 February 2002 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported recurrences of pain in both wrists, right elbow, and right knee without comment as to frequency and or duration of such symptoms.  “[The CI] states that there is no specific aggravating factors and the main trouble she has with the joints is in her right wrist in motions like opening jars and her right knee troubles her on long standing, but otherwise the conditions do not appreciably interfere with her daily activities, as long as she is on [medication]”.  Her PE revealed minimal painful motion of the right elbow as well as at the right knee when reaching the normal end (knee) range of motion.  Her diagnosis remained as SLE with polyarthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SLE condition at 10%, coded 6350 (lupus erythematosus, systemic).  The VA also rated the condition at 10%, based on the VA C&P examination 3 months after separation, citing exacerbations once or twice a year, or a condition which was symptomatic during the past two years.  The VA also rated polyarthritis of the right knee, right elbow and bilateral wrists secondary to SLE, 10%, 10% and 0% respectively.

Rating under VASRD diagnostic code 6350, is based on frequency and severity of exacerbations of disease.  Acute disease with frequent exacerbations producing severe impairment of health supports a 100% rating.  Exacerbations lasting a week or more, 2 or 3 times per year support a 60% rating.  Exacerbations once or twice a year or symptomatic during the past 2 years supports a 10% rating.  All panel members agreed that the CI’s SLE fell on the mild end of the spectrum of the disease.  Although there were physical symptoms as a result of the systemic condition, the minimal evidence of multiple exacerbations coupled with the absence of a time duration of such episodes clearly did not support a 60% rating.  Therefore, 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 SLE condition.

BOARD FINDINGS:  In the matter of the SLE condition and IAW VASRD §4.88b, the panel unanimously recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150915, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012616, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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