RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02332
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “diffuse multisystem polymyositis with interstitial lung disease” with a disability rating of 0%.

CI CONTENTION:  “Please 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 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 - 20050419	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diffuse Multisystem Polymyositis with Interstitial Lung Disease	5099-5002
5021-6825	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Diffuse Multisystem Polymyositis with Interstitial Lung Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI began suffering hand pain as well as pain, swelling and stiffness of the elbow, shoulder, hip and knee joints in August 2000.  By October 2000, the CI was unable to run due to pain, weakness and shortness of breath.  A chest X-ray and CAT scan showed bilateral interstitial infiltrates consistent with rheumatologic lung involvement.  He had distal (away from the center) joint infections treated with antibiotics and topical creams.  The CI’s hand pain was consistent with an early polymyositis (muscle inflammation) flare-up.  The examiner noted that polymyositis was a rheumatological disease that often had lung complications, most commonly interstitial lung disease with fibrosis (lung scarring).  The CI was placed on the TDRL on 11 December 2001 rated 60% based on a DLCO level (how much oxygen travels from the lungs to the blood stream) of 55%.

The 30 May 2003 TDRL evaluation resulted in the CI being retained on TDRL for “polymyositis with severe interstitial lung disease.”  The CI’s most significant complaint was shortness of breath without significant exertion.  The PEB noted that the CI was on methotrexate and prednisone at the time.  Physical examination showed normal lungs and no evidence of atrophy of the large muscle groups.  Chest X-ray showed moderate to severe interstitial lung disease.  

At the 18 January 2005 rheumatology examination, presumed to represent a second TDRL evaluation, 3 months prior to TDRL removal, the CI complained of polymyositis associated with interstitial lung disease and bilateral carpel tunnel syndrome.  The examiner noted the CI’s disease had progressed slowly due to the potent prescription drugs which the CI would require for life.  There was no report of current complaints and a physical examination was not in evidence.  

A 24 January 2005 civilian pharmacy medication profile showed chronic use of prednisone and methotrexate from 2003 to 2005.  The 8 April 2005 pulmonary function test (PFT), showed dyspnea (difficult breathing) after any exertion, a productive cough (produces mucus), and frequent wheezing.  Diffusion capacity of the lung for carbon monoxide by the single breath method (DLCO, single breath) was 94%, and forced vital capacity (FVC) was 73% predicted.  There was no significant response after administration of bronchodilators.  The CI was noted to be taking prednisone.  There was no VA examination proximate to TDRL removal in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the interstitial lung disease 0%, analogously coded 5099-5002-5021-6825 (rheumatoid arthritis-myositis-diffuse interstitial fibrosis), citing current DLCO (February 2005) at 94%, not meeting minimal rating criteria.  The panel first considered that polymyositis is a connective tissue disease characterized by muscle inflammation with approximately one-third of these cases associated with interstitial lung disease.  The Anti-Jo-1 antibody test (associated with interstitial lung disease, arthritis and/or Raynaud’s phenomenon) was positive.  The panel determined that VASRD code 6825 best captured the CI’s symptoms and rendered the highest rating IAW with §4.7 (higher of two evaluations).  Panel members also agreed that separating diagnoses for rating purposes would be pyramiding IAW VASRD §4.14.

The panel agreed the second TDRL evaluation which was most proximate to separation held the most probative value.  The chief complaint was respiratory difficulty; lungs were clear but the chest X-ray showed moderate to severe interstitial lung disease.  Symptoms had stabilized and there was no mention of musculoskeletal complaints to include loss of joint motion or painful motion.  Diagnoses of polymyositis and interstitial lung disease were rendered.  The April 2005 PFT reported continued shortness of breath after any exertion with productive cough and frequent wheezing, which was treated with an oral steroid medication.  Although the chose to rate the unfitting condition for DLCO results consistent with a 0% rating, the April 2005 PFT also documented FVC at 73% predicted.  The panel agreed that under the 6825 code, an FVC of 65-74% predicted meets the criteria for a 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the lung condition, coded 5002-5021-6899-6825.

BOARD FINDINGS:  In the matter of the diffuse multisystem polymyositis with interstitial lung disease, the panel recommends a disability rating of 30%, coded 5002-5021-6899-6825 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends 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	
Polymyositis with Interstitial Lung Disease	5002-5021-6899-6825	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

	

AR20180008663, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure