RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01809
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Air Traffic Control Operator, medically separated for “anaphylaxis after shellfish ingestion,” with a disability rating of 10%.  

CI CONTENTION:  “Hearing was not considered.”  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 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 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 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 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 - 20031204	VARD - 20040409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anaphylaxis after Shellfish Ingestion	7199-7118	10%	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Anaphylaxis Condition.  According to the service treatment record (STR) and the medical evaluation board (MEB) narrative summary (NARSUM), the CI had a history of anaphylaxis (generalized, rapidly progressive, life-threatening allergic reaction) prior to entering the military.  The 21 February 2002 report of medical examination documented “received immunotherapy [(IT) therapy with allergens that alters abnormal immune response] for allergies weekly for approx 6 mos, last dose approx 4-5 yrs previously.  Occasional symptoms well controlled c [with] sudafed.”  

A 24 April 2003 allergy/immunology evaluation documented “19 year old with history systemic allergic reaction to recent seafood ingestion.  Ate at Red Lobster - had various shellfish and fish.  Within a half hour developed hives.  Then developed swelling of the tongue, throat tightening, chest tightness/burning.  Taken to E.D. and treated with epinephrine, steroids, antihistamines.  Was kept in E.D. about 3 hours.  Sent home with 5 day course zyrtec.  Had never had problems with seafood previously.  Denies any other food allergy except similar (but milder) symptoms with honey. … Also very insect allergic.  Has had anaphylactic events to both bees (uncertain which) and fire ant (similar systemic symptoms, involving airway).  Had been on IT for insects about 5 years ago.  Was only on IT< 2 years.”  Skin allergy testing was positive for codfish, salmon, crab, and shrimp and negative for lobster and clam.  The assessment listed “History anaphylaxis to several types of seafood-shellfish and fish.  Also concerning history for hymenoptera [ants, bees, hornets, wasps, sawflies] (insect) allergy.”  

The 19 June 2003 radioallergosorbent tests ([RAST] radioimmunoassay blood tests to detect specific IgE antibodies) were positive for imported fire ants (IFA) and vespids (bees, hornets, wasps, sawflies).  On 24 July 2003 allergy/immunology began rush immunotherapy for mixed vespids.  “On day 3, after second injection, patient began feeling flushed (observed on face) and felt weak.  Otherwise vitals/exam were normal.  Patient was given one dose epinephrine 0.3 ml IM [intramuscular] and 10 mg Claritin po [oral] with resolution of symptoms.”  

On 14 August 2003 allergy/immunology began rush immunotherapy for IFA.  The allergist opined “Strongly recommend that patient receive allergy injections in the office and under the supervision of a board certified allergist given his sensitivity to these venoms (evidenced by serious reactions to the insects and IT reactions). … Recommend patient-carry epipen [epinephrine auto-injector pen] at all times.  F/U in 2 weeks for remaining rush IT to honey bee and wasp.”  

The 3 October 2003 MEB NARSUM by allergy, 3 months before separation, reported a history of systemic allergic reactions from seafood ingestion on several occasions.  “Since this initial incident in APR 2003, he has had problems with incidental ingestions of seafood as well.” …  “He has had anaphylactic events to both bees (uncertain which ones) and also fire ants.  With these episodes, he had similar systemic symptoms involving the airway.  He had been on immunotherapy for insects about five years ago but was on it less than two years.  He underwent [skin] allergy testing and was noted to be positive to codfish, crab, salmon and shrimp.”  The RAST testing was positive for honey bee, white hornet, yellow hornet, wasp, clam, shrimp, and crab.  He underwent immunotherapy to mixed vespids and had one mild reaction that was treated.  He subsequently went back to his base and has had one systemic reaction there following the immunotherapy.  He was brought back for fire ant rush immunotherapy.  This was successful; however, he was supposed to come back for the last rush immunotherapy to honey bee and wasp.  He has not been able to come down for this immunotherapy.”  Current medications documented “No medications except PRN [as needed] antihistamines.  He does carry an epipen for allergic emergencies.”  The final diagnoses listed 1. Anaphylaxis to fire ant, 2. Anaphylaxis to flying Hymenoptera including mixed vespids, wasp and honey bee, and 3. Anaphylaxis to shellfish.  

In the 12 March 2004 VA compensation and pension (C&P) examination, 2 months after separation, the CI did not claim service-connection for his “multiple allergies.”  The Allergies section documented “Fish, shell fish, bees, ants, mold, grass, trees, cats, dogs.”  The diagnosis listed “Multiple allergies.  The veteran does carry an EpiPen.  He is on Allegra, and Zyrtec.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 7118 code (angioneurotic edema) citing anaphylaxis after shellfish ingestion (diagnosis 3) and that anaphylaxis to fire ant (diagnosis 1), and anaphylaxis to flying Hymenoptera (diagnosis 2), were not conditions which constituted  physical disabilities per DoDI 1332.39 E5.  The VA did not service-connect the anaphylaxis based on the C&P examination 2 months after separation.  Angioneurotic edema/angioedema (rapid swelling of dermis, subcutaneous tissue, mucosa, and submucosal tissues) is rated based upon the frequency of attacks with, or without, laryngeal involvement.  Members agree the “swelling of the tongue, throat tightening, chest tightness/burning” described in the initial allergic reaction to seafood, before immunotherapy, was consistent with laryngeal involvement.  The other described incidents “problems with incidental ingestions of seafood,” “one mild reaction,” and “one systemic reaction there following the immunotherapy,” did not suggest laryngeal involvement.  Members agreed that findings were consistent with a 20% rating under 7118 (attacks without laryngeal involvement lasting one to seven days and occurring five to eight times a year, or; attacks with laryngeal involvement of any duration occurring once or twice a year).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the anaphylaxis condition, coded 7199-7118.  

BOARD FINDINGS:  In the matter of the anaphylaxis condition, the panel unanimously recommends a disability rating of 20%, coded 7199-7118 IAW VASRD §4.104.  There were 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	
Anaphylaxis after Shellfish Ingestion	7199-7118	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150701, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009329, 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