RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXX                                                                     BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200359                                                                   SEPARATION DATE:  20070801 
BOARD DATE:  20121107 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (11B10/Infantryman) medically separated for 
idiopathic angioneurotic edema.  The CI experienced two episodes of tongue swelling due to an 
unknown cause within a 4 month period beginning in April 2006.  Extensive evaluation including 
laboratory  and  allergy  testing  revealed  no  significant  abnormalities  and  treatment  with  oral 
anti-histamine  and  anti-inflammatory  medications  was  begun.    The  CI’s  episodes  were 
unpredictable and he was required to carry an epipen with him at all times; and, therefore did 
not  meet  the  physical  requirements  of  his  Military  Occupational  Specialty  (MOS).    He  was 
issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB 
identified  two  conditions,  idiopathic  anaphylaxis  and  angioedema  presumably  designated  as 
unfitting and obstructive sleep apnea (OSA) designated as “meets retention,” forwarding both 
to  the  Informal  Physical  Evaluation  Board  (IPEB)  for  adjudication.    The  IPEB  adjudicated  the 
idiopathic  angioneurotic  edema  condition  as  unfitting  and  rated  20%  with  application  of  the 
Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition, OSA, was 
determined to be not unfitting and therefore not ratable.  The CI appealed to the Formal PEB 
(FPEB), which affirmed the IPEB findings and he was medically separated with a 20% disability 
rating. 
 
 
CI CONTENTION:  “The Army rated me at 20% and I was rated by the VA at 60% for the same 
conditions.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    The  OSA  condition  requested  for 
consideration  and  the  unfitting  idiopathic  angioneurotic  edema  condition  meet  the  criteria 
prescribed  in  DoDI  6040.44  for  Board  purview,  and  are  accordingly  addressed  below.    The 
remaining condition, herpes, rated by the VA at separation is not within the Board’s purview.  
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 
Correction of Military Records. 
 
 
RATING COMPARISON: 
 

VA (2 Mos. Pre-Separation) – All Effective Date 20070802 

Idiopathic Angioneurotic 
Edema w/ Laryngeal 
Involvement 

Service FPEB – Dated 20070507 
Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

7118 

20% 

Idiopathic Angioneurotic Edema 

7118 

20% 

20070605 

OSA 

No Additional MEB/PEB Entries 

Combined:  20% 

Not Unfitting 

50% 
10% 

OSA 
Herpes 

6847 
7817 
Combined:  60%* 

20070605 
20070605 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation.  The Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 
which  the  Disability  Evaluation  System  (DES)  operates.    While  the  DES  considers  all  of  the 
member's medical conditions, compensation can only be offered for those medical conditions 
that cut short a member’s career, and then only to the degree of severity present at the time of 
final  disposition.    However  the  Department  of  Veterans’  Affairs  (DVA),  operating  under  a 
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting 
the Veteran’s disability rating should the degree of impairment vary over time. 
 
Idiopathic  Angioneurotic  Edema  Condition.    The  narrative  summary  (NARSUM)  prepared 
8 months  prior  to  separation  noted  onset  of  angioedema  in  the  spring  of  2006.    The  CI 
experienced  tongue  swelling  to  the  point  that  he  could  not  speak  properly.    He  denied 
shortness of breath or wheezing at that time.  He was treated with intramuscular Benadryl and 
his symptoms resolved within several hours.  About 3 months later, he had another episode of 
tongue angioedema.  During that episode, he had “severe laryngeal angioedema” with difficulty 
talking and breathing.  The patient denied drooling and stated the swelling was isolated to his 
tongue.    He  was  evaluated  by  an  ear,  nose  and  throat  (ENT)  physician  with  endoscopy  who 
identified  severe  tongue  swelling,  but  intact  airways.    The  CI  was  admitted  to  the  ICU  for 
observation and treated with Epinephrine, Prednisone and Benadryl.  He was discharged the 
following day.  Extensive work up by the Allergy and Immunology service failed to identify any 
identifiable  triggers.    Medications  at  the  time  were  Zyrtec,  non-sedating  anti-histamine,  and 
epipen.    Physical  exam  revealed  a  clear  oropharynx  and  clear  lungs.    Pertinent  labs  were 
negative  as  was  an  allergy  panel  comprised  of  local  allergens.    Impact  on  duty  performance 
was: “(The CI) can perform his job with sniper and infantry unit.  However, with his idiopathic 
anaphylaxis and angioedema, there is no way to predict another occurrence.  If he is deployed 
in a remote region, repeat occurrence may jeopardy his medical condition and the mission.”  At 
the MEB exam prepared 11 months prior to separation, the CI reported the tongue swelling and 
the  ICU  hospitalization  noted  above.    The  MEB  physical  exam  noted  a  normal  physical 
examination. 
 
The VA Compensation and Pension (C&P) exam prepared 2 months prior to separation had the 
following entry concerning the idiopathic angioneurotic edema condition:  “The condition has 
existed since 2006.  He has no leg symptoms of pain, dark pigmentation of the skin, eczema or 
ulceration.  The current treatment is Zyrtec.  There is no functional impairment resulting from 
the  above  condition.”    Pertinent  physical  exam  revealed:  Head,  ears,  nose  and  throat 
examination  is  performed  and  there  are  abnormalities;  findings  show  status  post  UPPP 
(uvulopalatopharyngoplasty), clear lungs and dermatographia (hives after scratching the skin, a 
type of physical urticaria). 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB utilized VASRD code 7118, Angioneurotic edema: (angioedema, anaphylaxis), and rated it 
20% specifically citing “rated for laryngeal involvement.”  The VA utilized the same code, 7118, 
and also rated it 20% specifically citing, “A 20 percent evaluation is warranted since there are 
attacks with laryngeal involvement of any duration which occurred once or twice a year.”  The 
rating criteria for VASRD code 7118 take into account the frequency and duration of attacks 
along  with  the  presence  or  absence  of  laryngeal  involvement.    The  documentation  suggests 

that  the  CI  had  three  episodes  of  angioedema  in  the  period  between  April  2006  and  March 
2007.  This includes an attack that occurred the evening of 1 March 2007, the day the CI initially 
declined an FPEB hearing, he then reversed that decision the next day.  On 2 March 2007, the CI 
requested  an  FPEB  hearing  based  on  this  third episode  of  angioedema.    While  the  NARSUM 
does state that the CI’s second attack did involve “severe laryngeal angioedema,” the NARSUM 
also  states that the  ENT’s  endoscopic evaluation  revealed  “severe tongue  swelling but  intact 
airways.”  The primary endoscopic report is not available for review.  This finding, along with 
the  CI  having  denied  any  “drooling”  during  the  second  attack,  casts  doubt  upon  the  actual 
presence  of  any  laryngeal  involvement  during  that  second  attack,  which  is  the  only  attack 
where laryngeal involvement is mentioned.  Without laryngeal involvement, the frequency and 
duration  of  the  CI’s  attack  would  warrant  a  10%  rating  for  attacks  without  laryngeal 
involvement  lasting  1  to  7  days  and  occurring  2  to  4  times  a  year.    Conceding  the  laryngeal 
involvement as did the PEB and VA, the CI’s attacks reach the next higher 20% rating for attacks 
without laryngeal involvement lasting 1 to 7 days and occurring 4 to 8 times a year, or; attacks 
with laryngeal involvement of any duration occurring once or 2 a year.  The doubtful presence 
of laryngeal involvement during the CI’s second attack of angioedema, if not conceded would 
result in a lower disability rating, is of no significance in the Boards rating recommendation as 
with  all  such  recommendations  (IAW DoDI  6040.44)  the  Board  may not  recommend  a  rating 
lower  than  that  received  prior  to  application.    After  due  deliberation,  considering  all  of  the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was 
insufficient  cause  to  recommend  a  change  in  the  PEB  adjudication  for  the  idiopathic 
angioneurotic edema condition. 
 
Contended PEB Condition.  The contended condition adjudicated as not  unfitting by the PEB 
was  OSA.    The  Board’s  first  charge  with  respect  to  this  condition  is  an  assessment  of  the 
appropriateness of the PEB’s fitness adjudication.  The Board’s threshold for countering fitness 
determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating 
recommendations,  but  remains  adherent to  the  DoDI  6040.44  “fair  and  equitable”  standard.  
Routinely  OSA  is  not  considered  unfitting  solely  on  the  basis  of  field  and  operational 
impediments  to  the  use  of  continuous  positive  airway  pressure  (CPAP).    This  condition  was 
profiled specifically noting “Must have access to electrical outlet for CPAP machine.”  It was also 
implicated  in  the  commander’s  statement  with  the  following  statement,  “(The  CI’s)  physical 
condition does not prevent him from working in his primary MOS, 11B.  However, due to his 
current profile, he cannot deploy to a field environment based on possibility of him having an 
allergic reaction, and the requirements of using a CPAP machine while sleeping.”  There is no 
evidence in this case that OSA was associated with any unfitting impairments not corrected by 
CPAP.  The medical records present for review contain the following statement: “Patient states 
that he is adjusting to therapy (CPAP) well and is noting less daytime somnolence, and does not 
snore when he wears the mask.”  The OSA was also not judged to fail retention standards and 
the  PEB’s  fitness  adjudication  was  therefore  expected  and  reasonable.    All  evidence  was 
reviewed  and  considered  by  the  Board.    After  due  deliberation  in  consideration  of  the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB fitness determination for the OSA condition; and, therefore, 
no additional disability ratings can be recommended. 
 
 
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 idiopathic angioneurotic edema condition and IAW VASRD 
§4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter 
of the contended OSA condition, the Board unanimously recommends no change from the PEB 
determination  as  not  unfitting.   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 

7118 

COMBINED 

20% 
20% 

Idiopathic Angioneurotic Edema  

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120405, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXX, AR20120021969 (PD201200359) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)