RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01681
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20081104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cardiopulmonary Lab Craftsman, medically separated for “rheumatoid arthritis” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:  

SERVICE PEB - 20080915	VARD - 20091027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rheumatoid Arthritis	5002	20%	Rheumatoid Arthritis	5002	20%	20090604	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Rheumatoid Arthritis (RA).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s RA condition began in January 2007 while deployed to Germany with complaints of wrist and shoulder pain and stiffness, and intermittent bilateral knee and hand pain.  In October 2007 she was referred to rheumatology due to worsening symptoms that affected her activities of daily living.  Lab results confirmed the diagnosis of RA.  The CI was started on daily prednisone medication for inflammation.

At the 13 May 2008 MEB NARSUM examination, 6 months prior to separation, the CI denied recent joint stiffness, pain or swelling.  The CI was undergoing immunosuppression therapy (Methotrexate).  She stated that her morning joint stiffness dramatically improved and swelling ceased shortly after the prednisone treatment was initiated.  She denied alopecia (hair loss), temporomandibular (ear) joint tenderness, neck pain and stiffness, chest-pain, shortness of breath or changes in gastrointestinal habits.  Physical examination showed no hand, elbow, knee, ankle or foot swelling or tenderness.  All joint ROM was “full” without exception.  The examiner opined that the RA was in remission and symptoms were well controlled with the immunosuppressive therapy.

At the 4 June 2009 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported bilateral shoulder pain secondary to RA.  Her pain was constant but was relieved with rest and steroid medication.  She complained of weakness, stiffness, heat, redness and lack of endurance.  The CI had remained on the Methotrexate and was also taking Humira injections (for arthritis) and Prednisone.  Physical examination showed no signs of bilateral shoulder edema, effusion, weakness, tenderness, redness, heat or guarding of movement.  All joint ROM was full and the neurological examination was normal.  The examiner noted normal X-rays of the cervical, thoracic and lumbar spine, shoulders, elbows, wrists, hips, knees and ankles.  The examiner opined that the overall RA effect on the CI’s usual occupation and daily activities was mild.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the RA condition 20%, coded 5002 (RA).  The VA also rated the RA condition 20%, coded 5002, based on the C&P examination.  The panel agreed there was no evidence of “symptom combinations productive of impaired health documented by objective examination findings,” recorded by the MEB NARSUM or VA examinations proximate to separation to support 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 RA condition.

BOARD FINDINGS:  In the matter of the RA condition and IAW VASRD §4.71a, the panel 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 20180119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01681.

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,

	

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings