RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02434
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Telecommunication Operator and Maintainer, medically separated for “Behcet's syndrome,” with a disability rating of 0%.

CI CONTENTION:  The CI contends her unfitting Behcet's syndrome continues to worsen and negatively impact daily activities; and, she contends for conditions not identified by either the MEB or PEB. 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 - 20031205	VARD - 20040908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Behcet's Syndrome	5099-5002	0%	Bechcet's Syndrome	7806	0%	20040713	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Behcet's Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Behcet's syndrome condition began in July 2002 with no specific injury or trauma.  The MEB forwarded “Behcet's syndrome, stable on medications” for PEB adjudication.  At a rheumatology evaluation dated 03 September 2003 the CI reported recurrent oral and vaginal ulcers.  The examiner noted a well-defined oral ulceration.  The examiner noted the possible diagnosis of Behcet’s syndrome (one manifestation is recurrent painful ulcers) and recommended oral prednisone (corticosteroid) daily.  A rheumatology note dated 25 October 2002 noted a diagnosis of Behcet’s Syndrome which was treated well controlled with Prednisone 20 mg daily.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 28 April 2003, 10 months prior to separation, the CI reported that she was diagnosed with Bechet’s.  The examiner visualized oral and vaginal ulcers upon physical examination.  The MEB NARSUM examination on 3 September 2003, 6 months prior to separation, noted complaints of recurrent constant oral ulcerations over the last two years and extremely, worsening painful vulvar ulcers beginning in early July 2002.  Physical examination showed well defined ulceration on the CI’s oral buccal mucosa of her lower lip with a yellow ulcer bed and multiple large ulcerations over her entire genital-vulvar surface particularly prominent on her left vulva.  The CI was observed to walk with a wide based gait.  Treatment notes dated January 2004 and March 2004 documented continuous oral corticosteroid therapy.  At the 13 July 2004 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported that she experienced mouth ulcerations every 2 weeks and uses a “miracle swish.”  Physical examination showed normal pelvic examination, no signs of skin disease and normal gait.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the Behcet's syndrome condition 0%, coded 5099-5002 (arthritis rheumatoid (atrophic) as an active process), citing controlled by maintenance corticosteroid therapy.  The VA also rated the Behcet's syndrome condition 0% coded 7806 (dermatitis or eczema), based on the VA C&P examination 5 months after separation, citing dermatitis or eczema involving less than 5% of the entire body or less than 5% of exposed areas affected, and; no more than topical therapy required during the past 12 month period.  The Board noted continuous corticosteroid therapy from September 2003 to the time of separation.  Board members agreed that the evidence supports a 60% rating for constant systemic therapy required during the past 12 month period.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 60% for the Behcet's syndrome condition, coded 7899-7806.  

BOARD FINDINGS:  In the matter of the Behcet's syndrome condition, the Board unanimously a disability rating of 60% coded 7899-7806 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Behcet's Syndrome	7899-7806	60%	
COMBINED	60%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151007, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005407, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and recommended that your percent of disability rating should be increased.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed).  I regret to inform you that I reject the Board’s recommendation and your application to the DoD PDBR is denied.  There is insufficient justification to support the Board’s recommendation in accordance with Army and Department of Defense regulations. 

	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. 

Sincerely,
						     
Enclosure