RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00879
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “severer chemical contact dermatitis” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 on 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 - 20070511	VARD - 20091015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Severe Chemical Contact Dermatitis	7806	10%	Allergic/Contact Dermatitis	7806	60%	20090220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Severe Chemical Contact Dermatitis.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s skin condition began in 2005 after exposure to pressured hydraulic fluid after attempting to disconnect a servicing hose.  Despite wearing the mandatory clothing and protective gear, the fluid soaked through to his skin for 12 hours.  At an Emergency Room visit on 24 August 2005 the CI reported peeling of the skin on his hands, which burned and itched, which resolved over the weekend when he had not been exposed to chemicals at work.  He was given a profile to avoid hydrocarbons and petroleum fuels.  Even with gloves he still seemed to get some jet fuel mixed with his perspiration, which leaked into his gloves and on his wrists.  On 7 September 2005 he reported when he was near jet fuel/hydraulic fluid his symptoms returned.  Based on an occupational illness/injury investigation dated 21 September 2005, the CI was advised to continue using nitrile gloves and replace them when worn, damaged, or soiled, and to consider a chemical barrier cream, if medically approved.  Thereafter, he began having skin reactions to deodorants/anti-perspirants, insect sprays, laundry detergent, lotions, colognes, hair care products among other common household chemical products.  Dermatologic consultation noted the CI had a history of generalized pruritus (itching) and reported irritation of the hands when pumping gas and washing dishes.  The consultant determined that based on history the CI had an irritant dermatitis, patch testing was not deemed appropriate, but treatment would consist of topical corticosteroids for flares.  In April 2006 the CI reported the skin on his hands peeled and left him with open sores after wearing his protective equipment gloves.   On examination the tips of his fingers were dry, but not deeply fissured and were only minimally peeling.  Scabbed areas of skin were present on the dorsum of both hands and on the left medial index finger there was a 1 cm x 1 cm ulceration without any signs of infection.  In June 2006 the CI complained of contact dermatitis on his hands.  On examination there were changes of the dorsal portion of the hands bilaterally consistent with post-inflammatory hyperpigmentation.  Treatment consisted of clobetasol ointment (a potent topical steroid) and the CI was advised of potential atrophy of the skin with its use.  At an examination dated 30 May 2007 the CI noted that skin symptoms were fully controlled with avoidance, be he was sensitive to cleaning chemicals as well as fuels.  Despite treatment and actual or potential chemical exposure, the severe chemical contact dermatitis condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chemical induced contact dermatitis” for PEB adjudication.  

At the MEB NARSUM examination on 14 March 2007, 4 months prior to separation, the CI noted had skin reactions when exposed to tools and aircraft parts as well as during a weapon qualification or even if there were potential trace chemicals on computers the CI might have used.  On physical examination the CI’s skin was normal except his hands bilaterally, which had atrophic pink plaques on the dorsum of both hands without lichenification (thickening) or signs of infection.  The examiner noted that the CI could not perform all aspects of his job; and daily cleaners, soaps, and shampoos could also cause skin reactions.  His commander noted on 16 April 2007 that JP-8 and other hydrocarbon and petroleum products all caused his contact dermatitis to flare up dramatically, be he filled a position completely unrelated to the his MOS duties.

At the VA Compensation and Pension (C&P) evaluation dated 20 February 2009, performed 19 months after separation, the CI reported a red rash with occasional open sores on exposed skin regions and felt feverish only during severe outbreaks.  He used white petrolatum and no corticosteroids or immunosuppressive medication and stated his rash was exposure or contact driven and frequently he had outbreaks of small patches on his arms and he wore long pants almost all the time to avoid exposure.  He noted on severe exposure he could get covered over the majority of his body, but his face was generally spared.  At the time of the examination his skin was clear.  However, the VA examiner recorded less than 5% exposed areas (head, face, neck and hands) and greater than 40% of the total body area were affected.     

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the severe chemical contact dermatitis under the 7806 code (Dermatitis or eczema).  The VA assigned a 60% rating for allergic/contact dermatitis under 7806 code, based on the C&P examination 19 months after separation, citing evidence of dermatitis or eczema involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period.  Board members noted that of the several examinations the CI had on active duty, only skin involvement of the hands was reported, while at the remote VA examination post separation, the CI’s hands were clear.  The STRs did not record the percentage of skin involvement.  Nevertheless while the VA examiner noted the CI’s hands were clear, he recorded the dermatitis involved greater than 40% of the body.  However, the VA Rating Decision (VARD) indicated that was an estimate of the extent of involvement at the time of a flare.  While the CI clearly had an accidental extensive exposure of his skin to pressured hydraulic fluid, there was no objective clinical indication that a dermatitis either acutely or chronically involved such a large surface area proximate to separation nor were systemic corticosteroids or immunosuppressive therapy used, although topical steroids were prescribed for use on the hands.  Therefore, Board members did not feel a rating of 30% or 60% is warranted in the absence of credible objective medical evidence of 20% to 40% or more than 40% of the entire body or exposed areas was involved with a dermatitis.  Members agreed that it would be speculative to presume 40% of the entire body or exposed areas occurred during flares in the absence of frequent urgent care or regular dermatology visits for more intensive therapeutic intervention.  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 skin condition.  

BOARD FINDINGS:  In the matter of the skin condition and IAW VASRD §4.118, the Board unanimously or majority 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00879.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

						     XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings