RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02821
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Chemical Operations Specialist, medically separated for “chronic urticaria” with a disability rating of 10%.   

CI CONTENTION:  PTSD-related issues.  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 - 20090824	VARD – 20091231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Urticaria	7825	10%	Chronic Urticaria	7825	10%	20090319	
Post-Traumatic Stress Disorder	Not Unfitting	Post-Traumatic Stress Disorder 	9411	10%	20090403	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Urticaria (Skin Lesions).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially developed painful nodules in June 2008 while deployed to Iraq; he was diagnosed with erythema nodosum (a hypersensitivity skin condition).  Although the nodules resolved, there were persistent pruritic (itchy) skin lesions, i.e., urticaria.  Provider entries in the STR documented that the urticaria was not initially responsive to various antihistamines but would clear temporarily with oral steroids (systemic immunosuppressive therapy).  Flare-ups were frequent, at times “daily,” although there was no explicit evidence that they were debilitating.  One provider stated they were “very uncomfortable, interfere with daily job performance;” but, another stated they posed “no physical limitations.”  All of the aforementioned STR clinical evidence preceded the 12-month interval before separation (applicable to rating criteria as below), and were not corroborated by more temporally probative evidence.  The distribution of the skin lesions was widespread, but no individual examination documented involvement of 20% or more of total or exposed body surface (applicable to alternative rating options).

The 19 March 2009 VA Compensation and Pension (C&P) examination, 8 months before separation, documented “hives all over” that “occur constantly,” although there was no further elaboration of severity or clarification of symptoms present at the time.  Routine activities, including strenuous ones, were unaffected.  Current treatment was limited to antihistamines and Singulair (not an immunosuppressant).  The physical examination recorded the absence of any rashes or lesions.  Of additional probative import, VA clinical notes soon after separation documented well-controlled symptoms on antihistamines only.

The 20 April 2009 MEB NARSUM examination (DoD/VA DES Pilot Program), 7 months prior to separation, documented the CI’s statement that “currently ... he is controlled with his medications; although he still gets itching ....”  Medications remained the same as in the C&P examination with no indication of a current requirement for steroids.   The physical examination recorded “no signs of skin disease.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10%, coded 7825 (urticaria), the same rating and code from the VA decision as per guidelines of the DoD/VA DES Pilot Program.  The VA rating decision, incorporating the STR and C&P evidence, referenced the 10% criteria of code 7825: “recurrent episodes occurring at least four times during the past 12-month period, and; responding to treatment with antihistamines.”  The next higher 30% rating specifies “recurrent debilitating [emphasis added] episodes occurring at least four times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control.”  The VA decision opined, “The evidence does not show these episodes are considered debilitating, nor do we have current evidence that systemic immunosuppressive therapy is needed to treat this condition.” 

Code 7825 is quite specific for the case, and the panel surmised that the only other option subject to consideration was rating for skin involvement under code 7806 (dermatitis or eczema).  Code 7806, however, requires at least 20% of the entire body or of exposed areas to achieve a rating higher than 10%, and, as noted above, these criteria were not satisfied by the evidence.  The panel next considered whether the 30% criteria of code 7825 were sufficiently supported to justify a higher rating recommendation; members ultimately agreed with the VA opinion as expressed above.  Although the 30% treatment criteria were satisfied earlier in the clinical course, it was not clear that the requisite “debilitating” criterion was supported even then; and, there was no evidence from the specified 12-month rating interval that supported either the treatment criteria or the presence of debilitating symptoms.  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 urticaria condition.

Contended PEB Condition:  Post-Traumatic Stress Disorder (PTSD).  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the urticaria condition and IAW VASRD §4.118, the panel recommends no change in the PEB adjudication.   In the matter of the contended post-traumatic stress disorder, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends that there be 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 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008421, 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.