RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00683
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “vitiligo, with exposed areas affected, with associated adjustment disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his condition continues to worsen.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 PEB - 20040225	VARD - 20050126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vitiligo with Associated Adjustment Disorder with Anxious Mood	7823	10%	Vitiligo with Associated Adjustment Disorder with Anxious Mood	9400-7823	10%	20041117	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Vitiligo with Associated Adjustment Disorder with Anxious Mood.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had decreased pigmentation in his face, hands, and trunk, and increased sensitivity to sunlight prior to his presentation at dermatology.  The CI was first seen by dermatology for his condition in July 2003 and began narrow-band ultraviolet B (UVB) treatment and given a temporary profile to limit his exposure to sunlight.  He responded well to therapy with a partial return of pigmentation and limited side effects.    The CI indicated he was unable to perform his duties due to the anxiety.  The physician noted that the CI participated in talk therapy with little benefit and his condition of adjustment disorder was expected to improve with a change in his occupational environment after completion of the MEB.   

At the time of the NARSUM on 3 February 2004, 4 months before separation, the CI was receiving UVB therapy.  The NARSUM physician was also his treating dermatologist.   Examination of the skin demonstrated extensive areas of depigmentation on the face, hands, and trunk.  There were areas of re-pigmentation within the depigmented areas, opined to be secondary to treatment.  He also had significant acne scarring on the face and back.  The physician noted an associated thyroid disease or other autoimmune process was not present.  It was noted that if the CI continued his therapy, there was an expectation of near-complete recovery, and resolution of the associated adjustment disorder.  The examiner diagnosed vitiligo with associated adjustment disorder with anxious mood. 

The VA Compensation and Pension (C&P) examination in November 2004, performed approximately 5 months after separation, the examination noted areas of decreased pigmentation in the hands, forearm, abdomen, and other areas of the body, representing about 7% of the whole body percentage.  

The Board directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB assigned a 10% rating under code 7823 (vitiligo).  The VA assigned a 10% rating using the analogous code 9400-7823.  A 10% rating under this code is the highest possible rating for this condition; therefore, there was not a pathway to a higher rating.  As noted above, the condition of adjustment disorder with anxious mood was forwarded to the PEB as associated with the vitiligo condition.  This opinion was supported by the treating psychologist and the consulting psychiatrist.  The NARSUM documented that the CI’s command decided to deploy him to Iraq, and the CI requested continuation of his therapy prior to deployment.  His request was denied and he developed symptoms of anxiety, diagnosed as an adjustment disorder. Psychiatric consultation dated 12 December 2003 indicated that the condition of adjustment disorder with anxious mood was secondary to the CI’s concern over his skin condition.  The psychiatrist opined that his anxiety symptoms were expected to improve after his MEB was completed and he was no longer in his current occupational environment.  Adjustment disorder is not a physical disability and is not ratable or compensable IAW DoDI 1332.38 (in effect at the time).  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 vitiligo associated with adjustment disorder condition.

BOARD FINDINGS:  In the matter of the vitiligo, with exposed areas affected, with associated adjustment disorder with anxious mood 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.  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 20140203, 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 XXXXXXXXXXXXXXXXXX, AR20160007259 (PD201400683)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA