RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2013-01986
BRANCH OF SERVICE:  Army  	BOARD DATE:  20150710
SEPARATION DATE:  20050406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Journalist) medically separated for discoid lupus erythematosus (DLE).  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3U2 profile and referred for a Medical Evaluation Board (MEB).  “Discoid lupus erythematosus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded undifferentiated connective tissue disease for PEB adjudication.  The Informal PEB adjudicated “discoid lupus erythematosus, involving primarily the face and some other exposed areas” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The undifferentiated connective tissue disease was not found to be separately unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB - Dated 20050225	VA* - VA Records not Available	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Discoid Lupus Erythematosus	7809-7806	10%	DLE	7809-7806	0%	Unknown	
Other MEB/PEB Conditions x 0 (Not In Scope)		
RATING:  10%	RATING:  	
*As noted in a VA letter to the CI dated 20130212.  Rating increased from 0% to 60% effective 20100712

ANALYSIS SUMMARY:  Neither the VA compensation and pension examination nor the VA rating decision proximate to separation were available for review.  Attempts to obtain these were not successful.  The Board adjudicated the case based on the available evidence.  

Discoid Lupus Erythematosus.  The record is scant and the majority of the history is from the narrative summary (NARSUM) which was dated 30 December 2004, 3 months prior to separation.  The record shows that the CI was incidentally noted to have skin lesions ultimately diagnosed as DLE during an evaluation for headaches in March 2003.  As part of the diagnostic work-up, tests of his liver function were ordered and showed an elevation of liver enzymes.  He was evaluated in gastroenterology for possible auto-immune hepatitis (an inflammation of the liver from attack by the individual’s own immune system) on 15 August 2003.  A diffuse rash on the abdomen, chest, and upper back was present which the CI reported had been present since age 18 or 19 (several years prior to accession).  An ultrasound was normal and the CI then underwent a liver biopsy.  This showed inflammation, but did not provide a specific diagnosis.  The liver functions subsequently returned to normal.  The CI was seen for headaches twice in early 2004 and diagnosed with recurrent migraines (prior history in high school) and the skin rash recurred.  (Per the commander’s statement dated 4 December 2004, the headaches responded well to medications and did not impair duty).  An autoimmune disorder was suspected, but apparently no definitive diagnosis was made and the CI was deployed.  During the deployment, he developed an eye problem (acute uveitis) and was sent from theater in September 2004 for diagnosis and treatment.  This condition resolved.  Two biopsies were done of his right cheek which confirmed the diagnosis of DLE.  He was then returned to his home duty station.  It is not clear from the record if his deployment was curtailed or not.  In Rheumatology in November 2004, he was diagnosed with an undifferentiated connective tissue disorder based on blood tests, the eye problems, and the skin lesions (DLE).  A CT scan demonstrated cysts in the liver; the clinical significance of these was not recorded.  However, his abdominal pain was noted to be tolerable and surgery was not indicated.  He was placed on medications for control of the disease progression.  He was restricted from direct mid-day sun exposure and also was on surveillance for potential eye problems from his medications.  He was diagnosed with DLE with undifferentiated connective tissue disease.  His prognosis was unknown, but he was not deployable with the requirement for sun avoidance and also for the monitoring for side effects from his medications.  His weight was stable and systemic signs of disease (such as fevers, organ involvement, eye problems) were either never present or resolved.  At the MEB examination on 17 December 2004, the CI reported that the uveitis had resolved.   The MEB physical exam noted hypo-pigmented (less color than normal) lesions of the left temple, mandible (jaw), and maxilla (cheek).  

The Board directed its attention to its rating recommendation based on the above evidence.  The action officer observed that while the CI was diagnosed at one time with undifferentiated connective tissue disorder, this diagnosis implies that the full criteria to formally diagnose one of the connective tissue diseases (one of which is DLE) had not been met.  The headaches were well controlled and pre-dated accession and the diagnosis of DLE.  The eye issues resolved.  His weight was stable and signs of systemic illness absent.  The skin lesions were noted to be from hypopigmentation and confined to the left side of the face, less than 5% of the body surface area.  The PEB rated the DLE condition at 10%, coded as 7809-7806 (DLE-dermatitis).  The VA apparently used the same codes and rated the condition at 0%; the reason for this adjudication is not in evidence nor was it obtainable.  The Board noted that the use of systemic drugs for control of the condition supports a 10% rating.  It found no route to a higher rating at separation.  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 DLE condition.  

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 DLE condition and IAW VASRD §4.118, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131025, 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 XXXXXXXXXXXXXXXXXXXX, AR20150012476 (PD201301986)

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