RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00963
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Armor Crewman, medically separated for “chronic dissecting cellulitis of the scalp” with a disability rating of 20%.  

CI CONTENTION:  No specific contention made.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070907	VARD - 20080418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Dissecting Cellulitis of the Scalp	7820-7830	20%	Dissecting, Scalp Cellulitis	7806	30%	20071010	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Dissecting Cellulitis of the Scalp.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s scalp condition manifested in 2007 while deployed to Iraq when he started experiencing recurrent and chronic infections on his scalp leading to painful pustules, cysts and patches of hairless, scared-down skin on his scalp.  Treatment with Minocycline and Doxycycline was attempted over a 3-month period, as well as Clindamycin and Rifampin without relief.  He was returned from deployment in May 2007 for inability to wear a helmet.  

The 19 June 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic painful infections of the scalp.  Physical examination showed multiple areas of alopecia (spot baldness), which were fluctuant and painful to touch.  There were no visible pustules and skin on the face, neck, chest, back, abdomen and arms was within normal limits.  The diagnosis was dissecting cellulitis of the scalp.   

At the 10 October 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported pain with wearing head gear.  Physical examination of the scalp revealed several areas of hair loss, with slight tenderness in those areas.  There was no evidence of inflammation, lesions, vesicles, crusting or drainage on examination.  The area of scalp involvement was approximately 50%.  There were multiple follicular lesions of the face confined to the beard area.  The findings were consistent with PFB [pseudofolliculitis barbae] with no evidence of pustules, vesicles or inflammation.  Total skin surface involvement was approximately 7%, and total exposed skin surface was approximately 35%.  

The panel directed attention to its rating recommendation based on the above evidence, and used the 2007 VASRD criteria (prior to the change in criteria effective 23 October 2008).  The PEB rated the scalp condition 20%, dual coded 7820-7830 (infections of the skin not listed elsewhere - scarring alopecia), citing “scarring alopecia affecting more than 40% of the body.”  The VA rated the scalp condition 30%, coded 7806 (dermatitis or eczema), based on the STR and C&P examination, citing involvement of approximately 35% of the total exposed skin surface.  

Chronic dissecting cellulitis of the scalp is an infection of the skin and is not listed elsewhere in the VASRD, but code 7820 was appropriate.  The note under code 7820 indicates the condition should be rated for disfigurement of the head, face, or neck (7800), scars (7801, 7802, 7803, 7804, or 7805) or dermatitis (7806), depending upon the predominant disability.  Code 7806 was predominant in this case.  The pre-separation C&P examination clearly documented that 20%-40% of the exposed area was affected warranting a 30% rating under dual code 7820-7806.  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 scalp condition, dual coded 7820-7806.  

BOARD FINDINGS:  In the matter of the scalp condition, the panel recommends a disability rating of 30%, dual coded 7820-7806 IAW VASRD §4.118.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Dissecting Cellulitis of the Scalp	7820-7806	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008596, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

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