RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03284
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Contingency War Plans/Health Services Management Journeyman, medically separated for “systemic lupus erythematosus (SLE)/mixed connective tissue disease” with a disability rating of 10%.   

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 - 20090420	VARD - 20091110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
SLE/Mixed Connective Tissue Disease	6399-6350	10%	SLE-Mixed Connective Tissue Disease	6350	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

SLE/Mixed Connective Tissue Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s lupus condition began in December 2007 with progressive morning stiffness in multiple joints to include the shoulders, knees, ankles, metacarpophalangeal joints, proximal interphalangeal joints and wrists.  The rheumatologist felt the CI had an overlap of SLE and mixed connective tissue disease and lab studies were consistent with the diagnosis.  The 12 January 2019 MEB NARSUM examination, 5 months prior to separation, noted complaints of fatigue and weight gain on steroids and lower extremity swelling and polyarthralgia.  She was treated with steroids and methotrexate (anti-inflammatory.)  Physical examination was essentially unremarkable, except for lower extremity ankle swelling.  There was no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SLE condition 10%, analogously coded 6399-6350 (lupus erythematosus, systemic (disseminated)).  The VA also rated the SLE condition 10%, coded 6350, based on the STR, citing exacerbations once or twice a year, or a condition which was symptomatic during the past 2 years.  The NARSUM noted the CI showed no evidence of exacerbations lasting a week or more, two to three times per year to meet criteria for a higher 60% disability rating.  Panel members agreed symptoms met criteria for 10% disability.  After due deliberation, considering all 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 SLE condition.  

BOARD FINDINGS:  In the matter of the systemic lupus erythematosus/mixed connective tissue disease condition and IAW VASRD §4.88, 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:

SAF/MRB

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03284.

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.