RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-01939
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Airborne Operations Craftsman, medically separated for “idiopathic urticaria and angioedema associated with cold urticaria” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20080326	VARD - 20080904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Urticaria and Angioedema 	7825	10%	Angioedema	7118	40%	20080305	
			Idiopathic Urticaria 	7825	30%	20080305	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Idiopathic Urticaria and Angioedema.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s idiopathic urticaria (hives) and angioedema (swelling of tissues) began during the fall of 2006 after developing hives while exercising.

The 4 October 2007 flight medicine evaluation, 8 months before separation, noted a 6-month history of increased shortness of breath, hives and swelling of his throat.  The 26 November 2007 MEB NARSUM allergy addendum noted an 18 to 24-month history of hives and soft tissue swelling caused by physical activity.  Symptoms progressed depending on the length of the physical activity or cold exposure (below 40 degrees) beginning with itching, to urticaria, to soft tissue swelling of the skin excluding soles and palms, to visual changes, then to swelling of lips and eyelids with some throat constriction [laryngeal involvement].  He carried an Epi Pen injector (for life-threatening, anti-allergic reaction).  The ice cube test was positive with urticarial reaction.  The physical examination which included vital signs was normal.  Lab studies were unremarkable.  Diagnoses of idiopathic (unknown source) urticarial-angioedema and cold urticaria were rendered.  The 25 January 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints as described above, which would resolve in 1-3 hours after exercise.  Physical examination was within normal limits and lab studies were normal.

At the 5 March 2008 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported the aforementioned symptoms occurred intermittently with each occurrence lasting up to 4 hours.  The number of attacks within the past year was over 100.  He reported difficulty breathing for 15-45 minutes [laryngeal involvement], with dizziness and fatigue that lasted several hours.  His symptoms affected his ability to perform daily functions during flare-ups.  He had received immunosuppressive medications for 6 or more weeks over the past 12 months with drowsiness and difficulty waking up.  The angioedema was associated with laryngeal swelling which occurred 6 times per year with each episode lasting a day.  Current treatment was Periactin (anti-allergy.)  He reported he was otherwise in excellent health.  Physical examination showed idiopathic urticarial angioedema with hypopigmentation of less than six square inches with no other findings on the skin.  Angioneurotic edema was present on the hands with hypopigmentation when cold was applied.  No laryngeal involvement was evident.  The remainder of the examination was within normal limits.  On the 22 April 2008 Report of Medical Assessment, the examiner documented the CI carried an Epi Pen injector for possible severe idiopathic urticaria and angioedema reaction [due to possible laryngeal involvement].

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the idiopathic urticaria and angioedema 10%, coded 7825 (urticaria).  The VA rated the urticaria 30%, also coded 7825 based on the C&P examination, citing recurrent debilitating episodes occurring at least four times during the past 12-month period; and, requiring intermittent systemic immunosuppressive therapy for control.  Additionally, the VA rated the angioedema condition 40%, coded 7118 (angioneurotic edema), citing attacks with laryngeal involvement of any duration occuring more than twice a year.

The STR, MEB NARSUM allergy addendum and C&P examinations documented a history and diagnoses of urticaria and angioedema with laryngeal involvement.  The panel noted that urticaria and angioedema are both allergic reactions that often occur together; therefore, separate ratings would be pyramiding in violation of VASRD §4.14.  The flight medicine, MEB NARSUM and VA examinations all documented attacks of laryngeal involvement that in totality occurred more than twice a year, proximate to separation, meeting the criteria for a 40% disability rating under code 7118.  Code 7825 was also considered but only supported a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 40% for idiopathic urticaria with angioedema, coded 7118.

BOARD FINDINGS:  In the matter of the idiopathic urticaria and angioedema, the panel recommends a disability rating of 40%, coded 7118 IAW VASRD §4.104.  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	
Idiopathic Urticaria and Angioedema 	7118	40%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX,

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01939.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.