RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01631
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Combat Engineer, medically separated for “scalp keloid, nine square inches,” 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 - 20040910	VARD - 20050510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Scalp Keloid, 9 Square Inches	7899-7801	10%	Scalp Folliculitis with Scarring and Alopecia	7830-7800	30%	20041209	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Scalp, Keloid, 9 Square Inches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s scalp keloid condition began prior to March 2003 after a rash on the scalp which gradually worsened.  The CI was evaluated by dermatology in July 2003 and was diagnosed with folliculitis declavans (inflammatory hair loss) with secondary keloid formation and pseudopelade of Brocq (hair loss of unknown etiology).  The CI underwent a shave excision of the keloid on 19 February 2004 due to pain and bleeding.  Post surgically the itching, pain, alopecia (hair loss), and occasional bleeding persisted.  Despite surgical treatment, the scalp keloid condition could not be adequately rehabilitated and the MEB forwarded significant keloid on the scalp for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2004, 5 months prior to separation, the CI reported unable to wear Kevlar due to keloid scar.  Physical examination showed a 6.5 cm by 3.5 cm keloid scar upper occiput.  The MEB NARSUM examination on 22 June 2004, 4 months prior to separation, noted complaints of large keloid scar that prevented CI from wearing his Kevlar.  The CI stated the keloid remained sore and bled.  The CI reported that Temovate cream alleviated the itch.  Physical examination showed an 8 cm x 8 cm (64 square cm) rubbery, slightly tender, and somewhat friable (the skin easily breaks with rubbing) keloid formation at the vertex of the scalp.  The examiner annotated the “significant keloid formation on his scalp prevents him from wearing Kevlar.”  

At the 9 December 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported persistent pain, hair loss (alopecia), and severe itching (pruritus) at the keloid site.  Physical examination showed a shiny 6.5 cm x 4.5 cm (29.25 square cm) scar on the crown of the head with associated alopecia and some folliculitis (inflammation of the hair follicles) along the edge of the scar.  There was white discoloration in the center of the scar, shiny and slightly irregular in contour, and irregular borders.  There was some pain with palpation of the scar and entrapped hair was noted.  There was no adherence to underlying tissue.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the scalp keloid condition 10%, coded 7899-7801 (Scar due to other causes, not of the head, face, or neck that are deep and nonlinear), citing “scalp keloid, nine square inches prevents reasonable performance of duties.”  The VA also rated the scalp keloid condition 30% coded 7830-7300 (Scarring alopecia- Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck), based on the VA C&P examination 2 months after separation, citing evidence of 2 characteristics of disfigurement, a scar at least one-quarter inch wide at its widest part and irregular surface contour.  

The Board noted that the PEB used an analogous rating to VASRD code 7801 which is not applicable to the head scars.  The VASRD code applicable to the head is 7800.  VASRD 7800 is a progressive rating based on the number of characteristics of disfigurement.  The 8 characteristics of disfigurement are: scar 5 or more inches (13 or more cm.) in length; scar at least one-quarter inch (0.6 cm.) wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo-or hyper-pigmented in an area exceeding 6 square inches (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding 6 square inches (39 sq. cm.); skin indurated and inflexible in an area exceeding 6 square inches (39 sq. cm.).  Board members agreed that evidence supports a 30% rating for a scar on the head with 2 characteristics of disfigurement (scar at least one quarter inch at its widest point (2.55-3 inch scar on the NARSUM and VA examinations) and the elevated surface contour of the scar (keloid).  A higher evaluation of 50 percent was not warranted as the record failed to show 4 or 5 characteristics of disfigurement.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the scalp keloid condition, coded 7800.  

BOARD FINDINGS:  In the matter of the scalp keloid condition, the Board unanimously recommends a disability rating of 30% coded 7800 IAW VASRD §4.118.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Scalp Keloid 	7800	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006429  , XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					       
Enclosure