RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03816
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “psoriasis” with a disability rating of 10%.  

CI CONTENTION:  “Psoriasis has continued and has increased into psoriatic arthritis of my lower back and joints.”  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 - 20050510	VARD - 20050921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psoriasis	7816	10%	Psoriasis	7816	30%	20050802	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Psoriasis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s skin condition began in December 2002 with a lesion on the bridge of his nose, which spread to the face, scalp, and chest.  Dermatology diagnosed him with psoriasis.  He did well until deployment to Iraq where he noted the onset of plaque-like scaling lesions on his face, scalp, chest, arms, and legs.  

The 3 March 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of severe long-time generalized skin plaques (psoriasis).  His medications included Dovonex and Clobetasol ointments.  Physical examination showed small coin-sized lesions on the left upper arm, the extensor surface of the left lower arm near the elbow, and the extensor surface of the right leg.  The physical examination was otherwise normal.  

At the 2 August 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported missing about a month of work on active duty due to flares of psoriasis and treatment.  Physical examination showed small itchy, red, and scaling plaques on the scalp at the crown, left upper chest, left mid anterior thigh, extensor surfaces of both arms (predominant on the right), and the flexor surfaces of both lower legs.  The examiner noted that less than one percent of the CI’s total body surface area was affected by psoriasis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the skin condition 10%, coded 7816 (psoriasis), citing lesions on the left upper arm, the extensor surfaces of the left lower arm near the elbow, and extensor surface of the right leg.  Therapy included Dovonex and Clobetasol ointment (a class I steroid).  The VA rated the skin condition 30%, coded 7816, based on the C&P examination, citing prospective flare-ups involving 30 percent of the entire body during the winter given the extent and severity of previous flare-ups that caused a 1-month absence from work. 

The panel noted that less than 1% of the entire body surface was involved at the time of separation.  Both the MEB and VA cited topical medications without a history of systemic therapy. Panel members agreed that the evidence did not support a rating higher than the PEB’s 10% rating.  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 skin condition.  

BOARD FINDINGS:  In the matter of the skin 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 20170503, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006244, 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