RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00042
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated from the Temporary Disability Retired List (TDRL) for “urticaria…” with a disability rating of 10%.  

CI CONTENTION:   The CI contends her disability rating should have been 30% based upon intermitted immunosuppressive therapy.  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 - 20060307	VARD - 20100126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Urticaria	7825	10%	Urticaria Angioedema	7825	10%	20100111	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Urticaria.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s urticaria (hives) condition began in 2002-2003 with painful recurrent rashes and welts that included episodes of angioedema that were not responsive to treatment and limited function.  The CI was placed on the TDRL in May 2004 with a 30% disability rating.  

During the 3 November 2005 TDRL Summary evaluation, 4 months prior to separation from TDRL, the CI reported chronic urticaria and angioedema with recurrent lesions several times per month while on chronic Prednisone therapy (steroid/immunosuppressive therapy) and Allegra (antihistamine).  The CI had “recurrent disease activity requiring physician visits every 1-2 months.”  Physical examination showed a single lesion on the right wrist with no secondary lesions.  The allergist indicated that the CI also had obesity and hypertensive disease associated with her treatment (prednisone).  The 9 February 2006 TDRL Summary Addendum, 1 month prior to separation (and after the Formal PEB), was signed by the same allergist as the TDRL evaluation.  The physician indicated that 1 month after the prior visit, that the CI’s steroids were increased to 10 mg per day for an exacerbation of urticaria and angioedema.  The physician indicated “these episodes are marked by swelling, significant pain and marked functional impairment.”  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The revised (administrative correction) PEB rated the urticaria condition 10% coded 7825 (urticaria), citing “recurrent episodes despite immunosuppressive therapy with no evidence that episodes are debilitating.”  The Formal PEB dated 1 June 2006 had a minority opinion, recommending a 30% disability rating and the US Army Physical Disability Agency (USAPDA) memo the same date as the revised PEB (7 March 2006) cited rationale of insufficient evidence to support “debilitating episodes” although indicating the CI met the requirements for requiring systemic immunosuppressive therapy.  The VA rated the urticaria angioedema condition 10%, coded 7825, based on the C&P examination 3 years and 10 months after separation from TDRL, citing the 10% rating criteria and stating “you may be entitled to a higher evaluation if you can provide objective evidence showing the treatment you have received for this condition in the last year.”  

The panel considered whether a higher rating (§4.7) was warranted under code 7825.  The CI was on continuous immunosuppressive therapy and the recurrent episodes were not responsive to treatment with antihistamines or sympathomimetic.  The USAPDA memo noted the CI missed church related educational program approximately twice a month and elected not to work and was not enrolled in college.  The TDRL Summary Addendum, indicated that the CI’s recurrent “episodes are marked by swelling, significant pain and marked functional impairment.”  The panel adjudged that the CI’s disability picture at separation from TDRL more nearly approximated the 30% criteria.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the urticaria condition, coded 7825.  

BOARD FINDINGS:  In the matter of the urticaria condition, the panel unanimously recommends a disability rating of 30%, coded 7825 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; 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	
Urticaria	7825	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170013202, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure