RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00468
BRANCH OF SERVICE:  Army	BOARD DATE:  20141003
SEPARATION DATE:  20071001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (M1 Armor Crewman) medically separated for a skin condition.  This condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  Psoriasis, characterized as medically unacceptable, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The initial MEB forwarded one other condition (Bipolar disorder).  However, a second MEB forwarded psoriasis and three other conditions (Bipolar disorder; vascular anomaly, right knee and right knee pain).  The Informal PEB (IPEB) adjudicated psoriasis as unfitting rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI appealed to the Formal PEB, but met two subsequent IPEBs which affirmed the initial IPEB findings and rating.  The CI made no additional appeals and was medically separated.

CI’s CONTENTION:  “Please consider all conditions.”

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 Veterans Affairs Schedule for Rating Disabilities (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:

Service IPEB – Dated 20070717	VA* – (3.3 to 3.8 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psoriasis	7816	10%	Psoriasis	7816	0%	20080110	
Bipolar Disorder	Not Unfitting	PTSD	9411	30%	20080123
20080108	
Vascular Anomaly
[Right Knee]	Not Unfitting	Residual Right Knee Meniscal Tear with Degenerative Changes	5003	10%	20080110	
Right Knee Pain	Not Unfitting					
Other x 0 (Not in Scope)	Other x 15 (Not in Scope)	20080110	
Combined:  10%	Combined:  70%	
*Derived from VA Rating Decision (VARD) dated 20080821 (most proximate to the date of separation (DOS))

ANALYSIS SUMMARY: 

Psoriasis (Skin Condition).  On 12 June 2006, the CI was seen by family practice and was diagnosed with psoriasis.  Shortly after that, he deployed to Southwest Asia and his skin disease worsened.  The CI was evacuated to Landstuhl with subsequent transport to CONUS.  With treatment he improved; however, the skin symptoms persisted and were problematic, so an MEB was initiated.  The first MEB narrative summary was dated 19 October 2006 and was written by his dermatologist at Fort Hood.  Physical examination (PE) at that time revealed multiple red, scaly plaques involving 15% of total body surface area (BSA).  There were no lesions on the face, scalp, or genitalia.  There was no joint inflammation of the digits, hands, or extremities.  On 20 February 2007 (approximately 7 months prior to separation), the CI was once again seen by his dermatologist.  Physical examination of the skin revealed 7-10% BSA involvement.  He was being treated with phototherapy, topical medications, and an oral retinoid called Acitretin (a.k.a. Soriatane) all anti-psoriasis treatments.  At the July 2007 PEB, the CI was found unfit for continued military duty, with a disability rating of 10%.  The CI concurred with the PEB findings, and waived a formal hearing.  He was separated from service on 1 October 2007.  

Three months later, on 10 January 2008, he had a VA Compensation and Pension (C&P) exam.  At that time, he was not using any anti-psoriasis medications, and he had no skin symptoms.  PE of the skin revealed no skin conditions.  According to the examiner, the previous skin condition appeared to have resolved.

The Board directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB and the VA chose different rating options for the skin condition.  For the readers’ convenience, the VASRD §4.118 language for code 7816 (psoriasis) is excerpted below:

	20 to 40 percent of the entire body or 20 to 40 percent of exposed 
		areas affected, or; systemic therapy such as corticosteroids or other 
		immunosuppressive drugs required for a total duration of six weeks 
		or more, but not constantly, during the past 12-month period	30

	At least 5 percent, but less than 20 percent, of the entire body, or at 
		least 5 percent, but less than 20 percent, of exposed areas affected, 
		or; intermittent systemic therapy such as corticosteroids or other 
		immunosuppressive drugs required for a total duration of less than 
		six weeks during the past 12-month period	10

	Less than 5 percent of the entire body or exposed areas affected, and; 
		no more than topical therapy required during the past 12-month 
		period…	0

The Board deliberated with regard to the appropriate disposition of this case.  The Board determined the CI improved significantly from February 2007 (7 months prior to separation to January 2008 (3 months after separation).  The Board gave the C&P exam in January 2008 significant probative value.  At that exam, there was no apparent evidence of the skin condition.  It affected 0% of the BSA, and appeared to have resolved.  The Board determined that it was more likely than not, that at the time of separation, the CI’s skin condition did not exceed the 10% rating criteria.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the (psoriasis) skin condition.

Other PEB Conditions.  Bipolar disorder, vascular anomaly, and right knee pain were all adjudicated by the PEB as not unfitting.  The Board’s main charge with respect to these three other conditions is to assess the appropriateness of the PEB’s fitness adjudication.  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.  These conditions were reviewed by the action officer and considered by the Board.  The Board noted that these three conditions were not profiled, and none of the conditions were specified as failing retention standards.  There was no indication from the record that these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 these conditions.  Therefore, no additional disability ratings are 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 psoriasis (skin condition) and IAW VASRD §4.118, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the Bipolar disorder, vascular anomaly, and right knee pain, the Board unanimously recommends no change from the PEB determination 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 20140512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150008510 (PD201400468)

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			     XXXXXXXXXXXXXXX			
				     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA