ZcRECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX 	CASE:  PD-2013-01567
BRANCH OF SERVICE:  Army	BOARD DATE:  20141121
SEPARATION DATE:  20041128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-5 (91J/ Medical Supply Specialist) medically separated for discoid lupus.  The discoid lupus condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  His profile permitted him to perform an alternate event to satisfy physical fitness standards.  He was issued a permanent P3/L2 profile and referred for a Medical Evaluation Board (MEB).  Discoid lupus was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions that were considered medically acceptable to the PEB.  The Informal PEB adjudicated “discoid lupus, controlled” as unfitting, rated at 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting therefore were not rated.  The CI non-concurred with the IPEB findings and recommendation, the IPEB proceedings were reviewed by the PEB which determined the “discoid lupus” condition warranted a 10% rating.  The CI made no further appeals and was medically separated.

CI CONTENTION:  The CI listed “Hypertension, low back pain (thoracolumbar herniated) dyspepsia, bursitis left knee, bilateral hearing loss, discoid lupus, tinnitus, migraine headaches, hemorrhoids, diabetes.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting discoid lupus condition is addressed below.  The requested low back pain (LBP), dyspepsia, left knee pain/bursitis and headache conditions, which were determined to be not unfitting by the PEB, are likewise addressed below.  The requested hypertension, bilateral hearing loss, tinnitus, hemorrhoids and diabetes were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Informal Recon  – Dated 20040706	VA - (3 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Discoid Lupus	7809	10%	Discoid Lupus	7809-7800	10%	20050209	
Low Back Pain	Not Unfitting	Low Back Pain	5243	NSC*	20050209	
Left Knee Pain	Not Unfitting	Left Knee, Chondromalacia	5019	10%	20050209	
Dyspepsia	Not Unfitting	Dyspepsia	7399-7346	NSC*	20050209	
Headache	Not Unfitting	Migraine Headaches	8100	NSC	20050209	
Other x 0 (Not is Scope)	Other x 4		
Rating:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20050412 (most proximate to date of separation)
VA service connected / rated on 20070326 VARD effective DOS

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Discoid Lupus.  The CI was seen in clinic 30 May 2001 for a -week history of red flaking and scabbing rash of nose, cheeks and inner ears.  He was treated with a topical steroid cream and sunscreen.  He was then referred to dermatology after a 7 week follow-up appointment.  He was diagnosed with discoid lupus in 2002 by dermatology.  His symptoms of face, ear, and nose rashes were well controlled with topical steroid cream medications.  The MEB narrative summary (NARSUM) physical examination on 29 March 2004 (8 months prior to separation), found minimal redness in both ears without other skin manifestations.  The VA Compensation and Pension examination on 16 February 2005 (3 months after separation), skin examination found right and left ear lobes hyperpigmentation, no ulceration, leveled and no scars.

The Board directed attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 7809 (discoid lupus erythematosus or subacute cutaneous lupus erythematosus) used by the PEB for a 10% rating, and codes 7809 (discoid lupus rated as), 7800 (burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck) used by the VA for the also for an 10% rating.  The Board did not find evidence of abnormal skin texture, visible or palpable tissue loss and either gross distortion or asymmetry for a higher rating under these codes.  The Board considered diagnostic codes 7801 (burn scars due to other causes not of head face, or neck), 7802 (burn scars due to other causes not of head face, or neck, superficial and non-linear), 7803 (scar, superficial), 7804 (scars, unstable or painful), or 7805 (scars), or 7806 (dermatitis).  Without evidence of scarring, or abnormal skin texture, there was no avenue for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the discoid lupus condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that LBP, dyspepsia, left knee pain/bursitis and headache conditions were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Low Back Pain Condition.  The CI was diagnosed with low back pain since 2000 after lifting a heavy weapon.  A MOS/Medical Retention Board in 2002 recommended retainment.  The commander’s statement on 25 March 2004 remarked the CI was physically able to perform his MOS and take an alternate Army physical fitness test with a permanent lower extremity, L2 profile, for back pain.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the LBP and so no additional disability rating is recommended.

Dyspepsia Condition.  There was no performance based evidence from the record that the dyspepsia condition significantly interfered with satisfactory duty performance.  The dyspepsia condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the dyspepsia contended condition and so no additional disability rating is recommended.

Left Knee Condition.  The NARSUM examination found some medial left knee joint line tenderness without effusion or instability.  There were no physical limitations at the time of the NARSUM examination.  The left knee condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left knee contended condition and so no additional disability rating is recommended.

Headache Condition.  The NARSUM documented the CI had a history of headaches since 2003, approximately four headaches per week, that he self-treated with Tylenol, without treatment at the troop medical clinic, nor required seeking medical care at the emergency room or receipt of quarters requirements.  The headache condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the headache contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the discoid lupus condition and IAW VASRD §4.118, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended low back pain, dyspepsia, left knee pain/bursitis and headache conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150006342 (PD201301567)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

						         
CF: 
(  ) DoD PDBR
(  ) DVA