RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05321
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “dermatitis with urticaria [hives]” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20051004	VARD – 20060410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dermatitis with Urticaria	7806	10%	Hives	7825	10%	20060127	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Dermatitis with Urticaria.  According to the service treatment record and MEB narrative summary (NARSUM), the skin condition began in September 2004 in the form of chronic intermittent rashes and severe itching.  The rashes began as small red bumps that coalesced into patches and became fluid-filled, and were worse when outdoors.  There was no significant response to anti-allergic or anti-itch medications.  The rashes were mostly on the extremities but occasionally occurred on the trunk as well.  They completely responded to bursts of oral steroids.  The CI had two emergency department visits in November and December 2004 for severe pruritus (itching) and wheals (red swollen marks).  

The 7 September 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent exacerbations on medication.  The CI reported that her ability to function and work efficiently was severely compromised due to the irritating and distracting nature of the rashes.  Medications included Claritin (anti-allergy) and Atarax (anti-histamine).  Physical examination showed a few pinpoint red papules on her forearms.  Her eosinophil count was normal and ANA (anti-nuclear antibody) was minimally elevated.  The commander’s statement noted the CI was still working in her primary job but with limitations.  Her condition required medication that made her extremely drowsy and unable to focus, hampering her ability to effectively work full shifts.  

At the 27 January 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported trying numerous medications as well as pulse doses of Medrol (steroid) over a 2-week tapering course.  She indicated the last time she had a tapering course of Medrol was about 4 months previously.  She took a Medrol tablet if she developed hives and took Atarax three times per day.  With Medrol, the hives quieted down within 24 hours.  Topical steroids had not helped and she did not need adrenaline shots.  She reported breakthrough hives about every 2 weeks and one Medrol tablet, in addition to the Atarax, generally controlled the outbreak.  She denied respiratory problems or problems in other organ systems.  Lab results were unremarkable.  Physical examination showed no active rashes or hives (0% of total surface area or exposed areas were affected).  Tonsils were mildly enlarged without drainage.  There was some swelling and tenderness of the left knee but the remainder of the examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the skin condition 10%, coded 7806 (dermatitis or eczema).  The VA also rated the skin condition 10%, coded 7825 (urticaria), 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.”  Panel members considered if there was evidence to support the next higher rating under code 7825.  There was no evidence of recurrent debilitating episodes that occurred at least four times during the past 12-month period which required intermittent systemic immunosuppressive therapy for control to support a 30% rating.  Although the CI had exacerbations while taking the medications to treat the skin condition, there were only a few red papules on her forearms, and lab results showed minimal evidence of allergic reactions.  The CI had not required a tapering dose of Medrol in the 4 months prior to the VA examination.  Breakthrough hives every 2 weeks were generally controlled within 24 hours by one Medrol tablet.  Panel members also considered a higher rating under code 7806, which requires evidence of 20% to 40% of the entire body or 20% to 40% of the exposed areas to be affected, but only a minimal amount of the body was affected.  Likewise, there was no evidence of systemic therapy with corticosteroids or other immunosuppressive drugs for a duration of 6 weeks during the past 12-month period to support a 30% rating.  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 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.  

SAF/MRB

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05321.

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.