RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01451
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Military Police, medically separated for “acute and chronic hidradenitis suppurativa” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.    

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20040322	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Acute and Chronic Hidradenitis Suppurativa	7820-7806	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Acute and Chronic Hidradenitis Suppurativa.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hidradenitis suppurativa (HS) condition began in January 2002 with infections in his skin and posterior buttock area.  The CI underwent surgery for some HS lesions in 2002 with skin grafts.  During the 12 months before separation the CI had recurrent development of abscesses of the abdomen and buttocks that required episodic treatment with oral antibiotics for greater than 6 weeks, but not constantly.  Multiple treatment visits included diagrams and descriptions that showed the area of skin involvement over time as both buttocks, the anal region, and stomach/suprapubic area.  The CI was not treated with immunosuppressive medications in the year before separation.  
During the 21 November 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination showed active skin disease of the “suprapubic area” and superior anal fissure.  

The 2 December 2003 MEB NARSUM examination, 5 months prior to separation, the CI was on no medications.  Physical examination showed skin graft scars in the superior bilateral gluteal area with scars of both posterior thighs at the skin graft donor sites.  There was “some evidence” of infection in the “suprapubic area and superior anal fissure.”  The MEB NARSUM examiner indicated that the CI may have to be on continuous antibiotics or receive steroid injections in the future.  The 20 February 2004 addendum noted “4% involvement of body surface area.”  There was no VA examination in evidence proximate to separation.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the acute and chronic hidradenitis suppurativa condition 0%, coded 7820-7806 (infections of the skin not listed elsewhere -dermatitis), citing involvement of 4% of total body surface area.  Rating of skin infections under VASRD 7820 instructs to rate under other skin codes (7806 among them) depending on the predominant disability.  Under the 7806 code, rating is based on percent of the body involved or type and duration of treatment required in the past 12 months.  A 0% rating under 7806 specifies no more than topical therapy required in the last 12 months.  The CI was treated with repeated oral antibiotic courses (more than topical therapy), which supports a 10% rating.  There was no evidence that the CI was treated with immunosuppressive medications to warrant a higher rating than 10%.  The MEB NARSUM addendum noted “4%” of body surface area involved.  However, it was not clear to the panel whether this referred to the percent of active involvement of skin at the MEB NARSUM examination or total involvement of the CI’s skin surface area.  The PEB adjudication acknowledged that the HS was a skin condition with acute and chronic manifestations.  In the panel’s estimation diagrams and description of skin involvement over time in the record reasonably support that “at least 5% …of the entire body” was involved (estimation of body surface area is not exact).  Based on these considerations the panel concluded that in this case a 10% rating and no higher was supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the hidradenitis suppurativa condition, coded 7820-7806.  

BOARD FINDINGS:  In the matter of the hidradenitis suppurativa condition, the panel unanimously recommends a disability rating of 10%, coded 7820-7806 IAW VASRD §4.118.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Acute and Chronic Hidradenitis Suppurativa	7820-7806	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record

AR20170008506, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs 

Sincerely,	
Enclosure