RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04482
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Communication Cable and Antenna Systems Journeyman, medically separated for “cystitis cystica” with a disability rating of 20%.  

CI CONTENTION:  “Review DoD disability ratings.”  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 - 20080822	VARD – 20090804 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cystitis Cystica	7512	20%	Cystitis Cystica	7529-7512	40%	20090701	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Cystitis Cystica.  According to the service treatment record and MEB narrative summary (NARSUM), the CI reported frequent urination since childhood, but symptoms worsened while in the military.  The CI was evaluated with laboratory studies, urinary flow studies and three different cystoscopies (a fibroscopic examination of the urethra and bladder).  He was ultimately diagnosed with cystitis cystica (cysts in the bladder).  

The 5 June 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of painful urination, increased urinary frequency with voiding every 30-60 minutes and urinary incontinence.  The physical examination was unremarkable.  In urology on 15 September 2008, 3 months prior to separation and 1 month after the final cystoscopy, the CI reported that he was voiding every hour and every 2 hours at night.  He was being treated for exposure to Trichomonas.  One month later on 27 October 2008, it was noted that a new medication combination had alleviated his symptoms as long as he was not physically active.  

The CI was seen in the VA urology clinic on 6 March 2009, 3 months after separation.  He reported lower abdominal pain, but denied LUTS (lower urinary tract symptoms, which include increased frequency of urination, incontinence and obstructive symptoms).  He was on no medications.  The examination was unremarkable.  A repeat cystoscopy was accomplished on 17 March 2009.  At the pre-operative examination, the CI again denied LUTS other than suprapubic pain and right flank discomfort.  He was working installing satellite dishes.  The cystoscopy was normal.  

At the 1 July 2009 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported frequent urination every 30-60 minutes during the day and 1-3 times a night.  The physical examination was unremarkable.  A mental health C&P accomplished on 13 July 2009 recorded that the CI was working full-time installing satellite dishes.  He reported a few days off due to either bladder or back pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cystitis cystica 20%, coded 7512 (cystitis, chronic).  The VA rated the cystitis cystica 40%, coded 7529-7512 (benign neoplasms of the genitourinary system causing chronic cystitis), based on the C&P examination 7 months after separation, citing urinary frequency every 30-60 minutes.  The panel agreed that code 7512 best fit the clinical condition.  The panel noted that a frequency of 30-60 minutes for urination supported a 40% rating and was reported at both the NARSUM and the VA C&P examinations.  However, in September 2008 the CI reported that the frequency was 60 minutes; and in October 2008, that his symptoms were relieved by medications unless physically active (not defined).  In March 2009, the CI reported no LUTS at two separate encounters.  The panel also observed that the CI was installing satellite dishes.  Therefore, the preponderance of evidence at separation does not support a rating higher than the 20% adjudicated by the PEB.  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 cystitis cystica.  

BOARD FINDINGS:  In the matter of the cystitis cystica and IAW VASRD §4.115b, 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 20170517, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 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-2017-04482.

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