RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2013-01981
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20140528
SEPARATION DATE:  20051126

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistical Specialist) medically separated for bilateral foot pain secondary to a toxic prescription drug reaction (Stevens Johnson Syndrome).  Her condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB also identified and forwarded for Physical Evaluation Board (PEB) adjudication one other condition, depression, as medically acceptable.  The Informal PEB adjudicated the bilateral foot condition as unfitting and rated it at 0%.  The remaining condition was determined to be not unfitting. The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 bilateral foot condition is addressed below.  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:

Service IPEB – Dated 20051020	VA - (Exam ~ 3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Condition…	5099-5003	0%	Steven-Johnson Syndrome	7899-7806	0%*	20060218	
			Bilateral Foot Pain	5299-5284	Not Service Connected	
Other x o (Not in Scope)	Other x 7	20060218 	
Combined:  0%	Combined:  70%	
Derived from VA Rating Decision (VARD) dated 20070117 (most proximate to date of separation [DOS]).  *Residual scarring (hypopigmentation) of the face, chest, and back from Stevens Johnson rated at 10% each.

ANALYSIS SUMMARY:

Bilateral Foot Pain Condition. On 16 February 2005, the CI was diagnosed with Stevens Johnson Syndrome (a potentially life threatening reaction which mimics the effects of a thermal burn) following the use of a Sulfa drug which had been prescribed over a week earlier for a urinary tract infection.  She was initially hospitalized at a local German hospital and then transferred to the US Army burn center in San Antonio, Texas where she remained for 30 days.  She was subsequently hospitalized at Landstuhl, Germany for depression secondary to her illness.  At a 3 May 2005 dermatology evaluation, it was noted that the diagnosis was toxic epidermal necrolysis (TEN), a more severe variant of the disorder.  She had pigmentary changes and hair loss.  At a 14 June 2005 primary care visit, the provider, after discussing her case with both legal counsel and the dermatologist, determined that she would require an MEB and that her conditions precluded retention in the Army.  The 11 July 2005 dermatology note documented that the TEN condition by itself was not grounds for separation, but that the scarring and psychosocial issues were.  Review of the records shows that her skin condition, including hair loss, was slowly improving while she remained on active duty.  The Board did note that the CI was treated for a left plantar wart in 2003 and early 2005 prior to the onset of the dermatological condition.  She was seen one time in June 2005, after her hospitalizations, but no treatment is recorded.  At the MEB examination on 26 July 2005, the CI reported no specific issues related to the TEN condition other than depression.  The MEB physical examiner noted hypopigmentation over the neck and trunk (anterior and posterior).  She was also tender to palpation over the soles of the feet.  No comment was made on the presence of a wart on either foot.  The narrative summary (NARSUM) was dated 22 August 2005, 3 months prior to separation, and based on an examination done that same day.  On examination, she continued to have tenderness over the soles of both feet.  Hypopigmentation with scaling (termed “scarring”) was noted on the trunk with moderate tenderness to palpation for those on her back.  At an MH evaluation, she had been found to meet retention standards from an MH standpoint.  The NARSUM examiner also noted that she was mandated to avoid sun exposure for a year, was allowed to wear foot gear of choice, and could not wear protective gear due to discomfort.  She was allowed to exercise as tolerated in the gymnasium.  At the VA Compensation and Pension examinations for her feet and skin, performed 3 months after separation, the CI reported that she took no medications for her foot pain, but would soak her feet in warm water if her pain became unbearable.  She denied flare-ups or the use of assistive devices.  She was attending college full-time and had no limitations in the activities of daily living.  On examination, she had some pain with deep palpation and on toe walking, but otherwise had a normal examination including her gait and posture.  There was not an abnormal wear pattern on her shoes.  The diagnosis was bilateral foot pain.  At the dermatological examination, she denied any symptoms from the previously reported “scarring.”  Mottled hypopigmentation of the face, back, and chest was noted.  The examiner noted that these were not “frank scarring,” but represented more accurately “post-inflammatory pigmentary alterations.”  There was neither pain to examination nor adherence to underlying tissue.  No limitation in motion or function was present.

The Board directs attention to its rating recommendation for the bilateral foot pain condition based on the above evidence.  The PEB coded it as analogous the degenerative joint disease using the 5099-5003 code and rated it at 0%.  The VA determined that a foot condition was no longer present.  On the VA examination, the foot was tender to deep palpation, but gait and posture were normal and she took no medications.  No functional impairment was present.  The CI was noted to be improving while on active duty and the record shows that this continued after the MEB/PEB up until the VA examination at least.  The evidence does not support a rating higher than the 0% adjudicated by the PEB.  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 bilateral foot condition.  The Board noted for the record that separate unfitting determinations for each foot could be supported based on the NARSUM, but that this provided no benefit to the CI and was therefore not recommended.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  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 bilateral foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131028, 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, AR20150002597 (PD201301981)

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:

Encl						 
CF: 
(  ) DoD PDBR
(  ) DVA