SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05343.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05343
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20061226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O1, Civil Engineer, medically separated for “inflammatory polyarthropathy involving feet, ankles and knees” 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 - 20061031	VARD - 20070817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Inflammatory Polyarthropathy… 	5009	20%	Inflammatory Polyarthropathy…	5002	20%	20070216	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Inflammatory Polyarthropathy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s inflammatory polyarthropathy began in June 2006 with unknown etiology.  The diagnosis was conferred by rheumatology and determined to likely be related to Human Leukocyte Antigen B27 (HLA-B27).   A foot specialist evaluation on 29 June 2006, 6 months prior to separation, noted CI complaints of bilateral foot and ankle pain of sudden onset.  Physical examination showed normal vascularity and intact neurological findings.  High arches on both feet were noted with “adequate” range of motion (ROM).  The examiner reported a diagnosis of inflammatory arthritis.  
The 29 September 2006 MEB NARSUM addendum, 3 months prior to separation, documented complaints of bilateral foot and ankle pain.  The examiner noted the CI’s progression to an acute exacerbation of inflammatory arthritis in June 2006, when he was transported to the emergency room barely ambulatory with inflamed feet and ankles, and febrile at 102.2 degrees.  He was treated and released on prednisone, but experienced another exacerbation (no date), again involving his feet, ankles, and knees.  He was treated with Solumedrol (glucolcorticoid) and a prednisone taper, and the examiner documented no additional “flares in the interim.”  

At the 16 February 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported working in an office.  The examiner noted that in 2006, the CI experienced two episodes of “nausea,” pain, and swelling involving his knees, ankles, shins and feet, and referenced a rheumatology diagnosis of B27 inflammatory polyarthropathy deemed as a possible autoimmune process.  Physical examination showed a normal gait, and no evidence of inflammation, tenderness, swelling or bilateral knee, tibia, ankle or foot abnormalities.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the inflammatory polyarthropathy 20%, coded 5009 (arthritis, other types), citing continued problems requiring treatment.  The VA also rated the inflammatory polyarthropathy 20%, but coded 5002 (arthritis rheumatoid), based on the C&P examination, citing “two exacerbations a year in a well-established diagnosis.”  Members agreed that the CI’s symptoms met criteria for a 20% rating under code 5002, but did not warrant a higher 40% without evidence of “symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year.”  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 inflammatory polyarthropathy.  

BOARD FINDINGS:  In the matter of the inflammatory polyarthropathy 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.