RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01429
BRANCH OF SERVICE:  army	SEPARATION DATE:  20040226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Behavioral Science Specialist, medically separated for “rheumatoid arthritis” with a disability rating of 20%.   

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 -20031117	VARD - 20040915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rheumatoid Arthritis	5002	20%	Rheumatoid Arthritis	5002	10%	20040618	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Rheumatoid Arthritis.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s rheumatoid arthritis condition began in November 2001 with insidious onset.  During the 27 August 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported swollen, painful wrists and continued use of methotrexate (immune system suppressant).  Physical examination showed swollen wrists bilaterally.  

The 10 October 2003 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of worsening bilateral pain and swelling in the wrists, ankles, and hands.  She reported “difficulty dressing herself, lifting a cup or glass to her mouth, washing and drying herself, bending down to pick up clothing from the floor, turning faucets on and off, and participating in sports.”  She had morning stiffness for 30 minutes with fatigue and pain rated at 2/10 and worsening throughout the day. She had difficulty performing repetitive tasks involving her wrists.  Bilateral wrist range of motion (ROM) showed flexion to 90 degrees and extension to 85 degrees.  Physical examination showed fullness over the left radial styloid area without warmth or redness. 

At the 18 June 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported intermittent wrist pain with cold, damp weather and overuse.  Repetitive use of her wrists caused flare-ups and she wore wrists splints as needed.  Physical examination showed normal, pain-free bilateral wrist ROM with (in degrees) dorsiflexion to 70, palmar flexion to 80, ulnar deviation to 45, and radial deviation to 20.   The ROM measurements were not limited by pain, fatigue, weakness, or lack of endurance.  While there was no right wrist tenderness, the examiner noted some swelling in the radial wrist aspect in the dorsum of the hand.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the rheumatoid arthritis condition 20%, coded 5002 (arthritis rheumatoid), citing hand, wrist, foot and ankle pain and swelling, no X-ray evidence of arthritic changes and no incapacitating exacerbations in the past year.  The VA rated the rheumatoid arthritis condition 10%, coded 5002 (arthritis rheumatoid), based on the C&P examination 4 months after separation, citing “asymptomatic in all joints but the right wrist” and no “medical evidence showing one or two exacerbations a year in a well-established diagnosis.”  The panel noted no limitation of motion or ankylosis for a rating of chronic rheumatoid arthritis residuals; and no evidence of incapacitating exacerbations occurring 3 or more times per year or symptoms productive of definite impairment of health for a 40% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the rheumatoid arthritis condition.  

BOARD FINDINGS:  In the matter of the rheumatoid arthritis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161004, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001593, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,					      
						      					
Enclosure