RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04093
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “urticaria,” with a disability rating of 10%.

CI CONTENTION:  PEB should have adjudicated a 30% rating.  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 based upon a 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 - 20060703	VARD - 20080115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Urticaria	7825	10%	Allergic Reaction	6502	NSC	20070703	
			Urticaria	7825	NSC	20070703	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Urticaria.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s urticaria (hives) condition began in August 2000 with recurrent episodes of urticaria during basic training that responded to injected Benadryl (antihistamine).  Urticarial reactions continued with exposure to running, strenuous activity or performing in a hot environment and additionally included shortness of breath (dyspnea).  Prophylactic medications were not completely effective and in 2006 the CI had multiple emergency department visits for acute treatment.  Despite treatment, the urticaria condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “cholinergic urticaria” for PEB adjudication.

The MEB NARSUM examination on 24 May 2006, 5 months prior to separation, noted complaints of exercise and heat induced urticaria.  She had between four and five acute episodes in the last year generally treated with steroids, Cimetidine (histamine antagonist) and injected Benadryl.  The physician indicated that “symptoms have markedly diminished since being on a permanent profile restricting her from running or performing in a hot environment or performing strenuous physical activity.  Physical examination was normal except for surgical scars.

At the 3 July 2007 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported that she got hives when she was outside in the heat for greater than 1/2 hour.  She stated that she avoided being outside and only had one attack of this condition since October.  She stated that her symptoms included her throat closing, itching, and hives on her chest and arms.  She took daily Allegra (antihistamine - fexofenadine) with good relief of symptoms.  Physical examination showed normal ear, nose, skin (aside from surgical scars), chest and cardiovascular examinations.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the urticaria condition 10%, coded 7825 (urticaria), citing the CI as essentially asymptomatic since adhering to profile restrictions and am essentially normal exam.  The VA did not service connect the urticaria condition, coded 7825 (urticaria) based on the VA C&P examination 9 months after separation, citing the condition neither occurred in nor was caused by service.  Additionally, the VA did not service connect allergic rhinitis, coded 6502 (septum, nasal, deviation of:  possible typo of 6522 - Allergic or vasomotor rhinitis), citing the condition neither occurred in nor was caused by service.

The MEB NARSUM and STR documented recurrent episodes occurring at least 4 times during the past 12-month period and responding to treatment with antihistamines, supporting the 10% awarded by the PEB.  Although steroids were used to treat acute episodes, the CI did not require intermittent systemic immunosuppressive therapy for control to support any higher rating.

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 urticaria condition.

BOARD FINDINGS:  In the matter of the urticaria 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.  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 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 
, AR20160018233 (PD201404093)

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