RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03741
BRANCH OF SERVICE:  Army	BOARD DATE:  20150701
SEPARATION DATE:  20040127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-4 (Combat Engineer) medically separated for a photosensitivity condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “Ultraviolet light B photosensitivity” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the photosensitivity condition as unfitting, rated 0%, with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  The applicant has asked for consideration of all conditions 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 20031205	VA* - (~8 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ultraviolet Light B Photosensitivity…	7899-7806	0%	Photosensitivity Ultraviolet B Light	7817	0%	20040914	
Other x 0 (Not in Scope)	Other x 3	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20040928 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Photosensitivity Condition.  Review of the service treatment record found that the CI experienced a history since childhood of skin sensitivity from sun exposure.  He did not experience significant difficulty because he avoided sun exposure.  While in basic training he was exposed to sunlight for prolonged periods, and developed a red, burning, itching, sometimes blistering rash on his arms and face.  Specialized testing in May 2003 involving exposure to measured doses of ultraviolet light (UV) determined that the CI was sensitive to UVB light.  

An evaluation on 15 May 2003 (8 months prior to separation) found scattered patches on the dorsal aspect of arms and hands.  The face was clear.  Examinations by dermatology on 3 June and 30 June 2003 found no skin lesions.  An exam by dermatology on 18 July 2003 (6 months prior to separation) recorded “a few small pink macules (circumscribed alteration in skin color less than 2 centimeters in size) with scale on arms.”  On the Report of Medical Assessment on 30 July 2003 the CI wrote that he was limited in performance of his duties because he could not go outside during daylight for more than 15-20 minutes at a time.

The MEB exam on 8 August 2003 (6 months prior to separation) noted some old blisters on the forehead from sun exposure three days previously.  The narrative summary (NARSUM) on 7 October 2003 (4 months prior to separation) noted that the CI did not develop skin sensitivity symptoms in the absence of light exposure.  He developed denuded red patches on exposed skin, especially the nose and forearms, after sunlight exposure.  He sometimes developed vesicles (small blisters) that could become larger.  While outdoors, frequent application of sun block was advised.  The last exam performed by the NARSUM examiner was six days previously, at which time the CI was doing well but did have skin eruptions on the face, nose and extremities.

At the VA Compensation and Pension (C&P) exam on 14 September 2004 (8 months after separation), the CI reported that symptoms were intermittent and depended on sun exposure.  His condition precluded working in his desired field (construction), so he worked in a factory where he had not missed any time from work due to his condition.  Examination of the skin was normal, and the examiner indicated that 0% of the body surface area was currently affected.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding approaches in arriving at the same 0% rating.  There is no VASRD code for the CI’s condition, but the respective options by the PEB and VA were reasonable.  A rating under the PEB’s analogous 7806 code (dermatitis or eczema) is based on the percentage of total body surface area, or exposed body surface area, affected; or the requirement for systemic corticosteroid or immunosuppressive therapy.  The Board concluded that the evidence at hand did not support a compensable rating via this pathway since the condition was generally associated with a state of normal skin, and the clinical manifestations were short-term and occurred exclusively in the setting of unique, avoidable exposure.  There was no route to rating based on systemic steroids or immunosuppressive therapy, or ratable scars or disfigurement.  The next higher 10% rating under the VA’s 7817 coding option (exfoliative dermatitis) requires “any extent of involvement of the skin, and; systemic therapy such as therapeutic doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen with long-wave ultraviolet-A light) or UVB (ultraviolet-B light) treatments, or electron beam therapy required for a total duration of less than six weeks during the past 12-month period.”  Even conceding the “any extent of involvement of the skin” stipulation, the relevant systemic therapy requirement was not met; therefore a rating higher than 0% was not warranted via this pathway.  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 photosensitivity 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 ultraviolet light B photosensitivity 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 20140811, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

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, AR20160003071  (PD201403741)

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:

CF:
( ) DoD PDBR ( ) DVA