RCORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200544 SEPARATION DATE: 20030531 BOARD DATE: 20130228 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (77F/Petroleum Supply Specialist) medically separated for urticaria. She developed frequent recurrence of hives early in her service career and the condition progressed to intolerance of numerous environmental allergens. Despite a protracted trial of various treatments, the condition remained incompatible with the requirements of her Military Occupational Specialty. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB referred the condition to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the urticarial condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated with that disability rating. CI CONTENTION: “*chronic uticaria* This condition started once entered in Basic Trng (1994) and has yet to cease or improve. Due to this problem my life has changed drastically and with the lower rating, all of my privileges were lost (Px, commissary). The disability award for chronic uticaria was increased to 30% as of a notice being mailed as of July 2010.” The CI additionally submitted two letters with her application; one reiterating the details of the urticaria condition as above, and the other drawing attention to a service-connected left knee condition. SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The rated urticaria as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview. The left knee condition as contended by the CI was not recognized by the MEB or PEB and is, therefore, not within the purview of the board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Corrections of Military Records. The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation. RATING COMPARISON: Service PEB – Dated 20030318 VA - (2 Mos. Pre-Separation) Condition Code Rating Condition Code Rating Exam Urticaria 7199-7118 10% Urticaria 7825 10% 20030411 No Additional MEB/PEB Entries Other x 3 20030411 Combined: 10% Combined: 10% ANALYSIS SUMMARY: Urticaria. The CI developed a pruritic skin rash in the eighth week of her basic training. After initial treatment, the condition intermittently reappeared and was treated with multiple dermatologic preparations. Numerous diagnoses were considered including drug reaction, contact allergies, insect bites and skin fungus. A skin biopsy for definitive diagnosis in December 2002 revealed only chronic inflammation and a diagnosis of urticarial vasculitis (hives) of uncertain etiology was applied. The condition was not controlled with medication and the CI was referred for MEB and PEB processing. The records in evidence reflect that the skin condition was treated with systemic steroid medication on two occasions for a total of 10 days in the 9 years prior to separation, and one occasion for 5 days in the year after separation. The records also document no episodes of incapacitation requiring steroid medication or placement on quarters in the same period. The MEB narrative summary physical exam on 27 December 2002, 5 months prior to separation, documented urticarial plaques on the CI’s left shoulder and areas of post-inflammatory hyperpigmentation. The CI was having no pruritus at the time. At the VA Compensation and Pension exam performed 11 April 2003, a month prior to separation, the CI reported that the hives, when occurring, would respond to oral antihistamine medication. She reported no history of any throat swelling, dysphagia or shortness of breath since onset of the condition. The Board directs attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the condition 10%, but under separate codes. The PEB chose code 7118, analogous to laryngeal edema; the VA chose code 7825, urticaria. The Board reviewed the coding and unanimously agreed that code 7825 more accurately reflected the clinical course and pathologic findings in the case. Under this code, a higher rating of 30% requires recurrent debilitating episodes of urticaria occurring at least four times a year requiring intermittent systemic immunosuppressive therapy for control. The Board unanimously agreed that this rating was not supported by the evidence in record. The Board was unable to find a pathway to a higher rating under any other applicable VASRD code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the urticaria condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the urticarial condition and IAW VASRD §4.118, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Urticaria 7118 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120604, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20130005352 (PD201200544) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)