RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-01988
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Protection Specialist, medically separated for “delayed healing of pilonidal cyst excision” with a disability rating of 10%. 

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 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 - 20051108	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pilonidal Cyst	7899-7820	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Pilonidal Cyst.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a long-standing history of pilonidal cyst disease with periodic surgical interventions.  The last procedure, 5 months before separation, was an excision and drainage in July 2005.  Surgical notes in the STR after the final procedure documented an improving course, although the wound was consistently characterized as “non-healing.”  It was clear that the wound depth was fairly superficial (subcutaneous, not to fascia).  There was no wound adherence, intractable abscess or cellulitis, or other complications.

During the 1 October 2005 MEB NARSUM examination, 3 months prior to separation, there was no documentation of purulent drainage, fever, bowel problems or other associated symptoms.  On examination the provider documented, “The sacral gluteal cleft demonstrate[d]s an open, seeping, approximately 1.5 cm in depth wound and approximately 6 cm in length.  There is a small amount of hypergranulation tissue over and around the wound.”  Subsequent STR entries in the interval before separation, and for a few months afterwards, documented continued improvement and a progressively smaller wound.  There was no VA examination proximate to separation in evidence; however, the 2-year post-separation VA examination documented a healed, but tender, scar of 0.2 cm depth.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pilonidal cyst 10%, analogously coded 7899-7820 (infections of the skin not listed elsewhere).  The PEB’s analogous code was clinically reasonable, but did not provide a direct rating scale or criteria and instead deferred to the most favorable scar or dermatitis skin code.  The PEB did not clarify the sub-code or rating criteria applied.  There is no specific code for pilonidal cyst, chronic abscess or similar pathology.  Given the surface area and ratable findings in evidence, no criteria are satisfied for a rating higher than 10% under any scar code (§4.118), and the minimum 10% criteria are not satisfied for the single dermatitis code 7806.  The panel also considered analogous rating under digestive system disorders (§4.114), specifically codes 7335 (anal fistula) and 7336 (hemorrhoids), but minimum 10% criteria were not satisfied by either of those codes.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the pilonidal cyst.

BOARD FINDINGS:  In the matter of the pilonidal cyst and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear xxxxxxxxxxxxxxxxxx:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01988.

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 appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.