RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01288
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20080321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Surgical Technologist Assistant) medically separated for psoriatic arthritis, rated 20%.

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 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 20080321	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psoriatic Arthritis	5009	20%	Psoriatic Arthritis	5009	20%	20080730	
Psoriasis	EPTS	Psoriasis	7816	0%	20080730	
Other MEB/PEB Conditions x 3 (Not In Scope)	Other x 4(equals SC, NSC & deferred)	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20081216(most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Psoriatic Arthritis Condition.  The first record in evidence for the psoriatic arthritis is an internal medicine note dated 12 April 2006.  The CI reported a 6-year history of psoriasis and non-painful swelling of the joint between the bones of the right thumb (1st interphalangeal joint [IPJ]).  The rash was well controlled with medications, but pitting of the nails was noted (associated with psoriatic arthritis).  He was also noted to have swelling of the joint lining and a rheumatology evaluation was recommended.  An X-ray showed joint changes consistent with psoriatic arthritis.  He was then seen in family practice and noted a history of swelling of the right thumb for 10 years, but now also had pain which was aggravated by his occupation (operating room technician).  He was noted progressive pain at the next few family practice visits.  He was seen in Rheumatology on 8 February 2007 and reported psoriasis since 1999.  The diagnosis was confirmed and he was begun on Humira (an inflammatory response modifier).  He also reported difficulty with fine motor skills and was placed on LIMDU.  At the end of the first LIMDU period, it was not thought that he would be able to return to full and he was referred for a PEB.  The narrative summary (NARSUM) was dated 24 October 2007 and noted that the CI had a partial response to Humira and that he could not perform his assigned duties.  He reported joint pain in both thumbs with a decrease in fine motor dexterity.  He also reported bilateral foot pain with prolonged standing and anterior knee pain.  Systemic symptoms were not recorded and his weight was increased from 8 months earlier.  On examination, he had nail changes and a few psoriatic plaques.  He had swelling of the first joint of both thumbs (as above) and the right great toe.  X-rays showed mild joint space narrowing (early degenerative change) on the left thumb IPJ and bone and soft tissue changes on the right.  At the MEB examination on 3 December 2007, 4 months before separation, the CI reported decreased dexterity and grip in both hands and difficulty standing for prolonged periods.  The MEB physical examiner noted several psoriatic plaques and swelling of the right IPJ.  At the VA Compensation and Pension (C&P) examination performed on 30 July 2008, 4 months after separation, the CI reported that his psoriasis started in 1999.  He was using a topical cream, but was not using the Humira.  He had no functional limitations from the rash and was working in a cable company (actual duties not recorded) without time lost from work.  Systemic symptoms were not recorded and he was noted to be over-weight.  He reported that the joint pain started in February 2007.  He also noted that he could not walk for over 10 minutes, stand for over 5 minutes, or lift over 15 pounds.  On examination, he walked with a limp.  He had superficial patches of psoriasis which totaled less than 1% of the exposed surface area and less than 1% of the total body surface area.  He had swelling and tenderness of the left thumb and right great toe.  X-rays showed osteoarthritis of the right first IPJ (hand) and left first IPJ (foot).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the psoriatic arthritis 20%, coded 5009 (arthritis, other, rated as rheumatoid arthritis [5002]).  The Board noted that incapacitation was not recorded or was there objective evidence of systemic health impairment.  No route to a rating higher than the 20% adjudicated by both the PEB and VA was found.  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 psoriatic arthritis condition.  

Psoriasis.  The PEB adjudicated the psoriasis condition as an EPTS condition and the CI concurred with this assessment.  No comment was made on permanent service aggravation implying that the PEB did not find this to be present.  Review of the record shows that the CI did not disclose the history of psoriasis at accession and that it was not noted on the accession physical.  However, 8 days after accession, on 23 August 2005, the CI presented with the complaint of psoriasis of the scalp.  The next record in evidence was dated 12 April 2006 and recorded that the CI had a 6 year history of psoriasis well controlled with medication as well as a 6-7 year history of right thumb IPJ swelling.  An occupational examination on 24 May 2006 documented psoriasis plaques on his elbows, shins, and knees controlled with topical steroids.  Both the rheumatology evaluation on 8 February 2007 and the VA C&P recorded the onset of the psoriasis in 1999.  The Board considered the evidence.  It clearly shows that the CI had psoriasis for 6 years or more prior to accession and was treated within days of reporting to his first duty station.  Psoriasis is a condition which waxes and wanes and the minimal number of lesions present on active duty is consistent with a stable condition existing prior to accession.  The Board noted that no lesions were documented on the accession medical, but this is not inconsistent with the course of the disease.  It could also be explained by the fact that the CI reported self-treatment with topical steroids, which could mask the presence of small lesions, and also by the presence of plaques in locations not normally examined in detail (such as the scalp).  The Board did not find evidence sufficient to overturn the PEB adjudication that the psoriasis was an EPTS condition without permanent service aggravation.  Accordingly, no change in the PEB adjudication is 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 psoriatic arthritis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the psoriasis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication as an EPTS condition.  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 20140226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 19 May 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN