RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02168
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20050629

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

CI CONTENTION:  The anthrax vaccine caused his condition, he was given a higher rating for his conditions by the VA, his conditions continue to worsen and negatively impact daily activities and he should be better taken care of than he has.  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 – 20050608	VARD – 20040909	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Urticaria	7825	10%	Chronic Urticaria	7825	10%	20040809	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Urticaria.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic urticaria (hives) condition began in January 2003 after performing pushups on a grassy area.  Despite treatment including a prednisone taper over a year, the CI continued to have outbreaks every 1-2 weeks during the winter and more often during the summer.   The CI was separated and placed on TDRL on 11 May 2004.

At the 9 August 2004 VA Compensation and Pension (C&P) evaluation, 9 months before TDRL removal, the CI reported he had an anthrax immunization, developed a rash, and had two more immunizations with the development of urticaria.  Since TDRL placement, he reported two episodes of urticaria and five to six episodes of angioedema requiring treatment with epinephrine beyond the medications he regularly took including montelukast, loratadine (an antihistamine), and ranitidine.  Physical examination showed no active urticaria or angioedema. 

The 3 May 2005 MEB NARSUM examination, 2 months prior to TDRL removal, noted complaints of urticaria and angioedema secondary to anthrax vaccination. The CI still had still had urticaria outbreaks, but had not had any angioedema for 6 months.  Medications included Zantac, Claritin (loratadine, an antihistamine), and Singulair.  Physical examination showed no urticaria or angioedema.  Pulmonary function studies were interpreted as acceptable and reproducible with no evidence of obstruction. The examiner noted the urticaria continued to be an ongoing problem that required multiple medications to control the frequency and duration of symptoms.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic urticaria condition 10%, coded 7825 (urticaria), citing at least four recurrent episodes in the past year responding to treatment.  The VA rated the chronic urticaria condition 10%, coded 7825, based on the C&P examination, citing recurrent episodes occurring at least four times during the past 12-month period, and; responding to treatment with antihistamines or sympathomimetics.  

The panel agreed the chronic urticaria justified at least a 10% rating.  However, proximate to TDRL removal, the CI did not have documented “recurrent debilitating episodes occurring at last four times during the past 12-month period, and; requiring intermittent systemic immunotherapy for control” to warrant a 30% rating nor did he have “recurrent debilitating episodes occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy” to warrant a 60% rating since he was not treated with or used cortisone or any immunotherapy; however, he did take montelukast, which is not a classic immunotherapy medication.   After due deliberation, considering all of 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 chronic urticaria condition.  

BOARD FINDINGS:  In the matter of the chronic urticaria condition and IAW VASRD §4.118, 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 no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010651, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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