RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  NAVY 
SEPARATION DATE:  20030107 

 
NAME:  X 
CASE NUMBER:  PD1200884 
BOARD DATE:  20120212 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PO3/E-4 (ET3/9604 Electronics Technician), medically 
separated  for  dermatographic  urticaria.    The  CI  had  a  long  history  of  rash  and  hives  which 
developed prior to her entering the Navy.  The CI did not improve adequately with conservative 
treatment  and  was  unable  to  perform  within  her  rating,  meet  worldwide  deployment 
standards,  or  meet  physical  fitness  standards.    She  was  placed  on  limited  duty  (LIMDU)  and 
referred for a Medical Evaluation Board (MEB).  The MEB forwarded dermatographic urticaria, 
chronic, to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions 
appeared  on  the  MEB’s  submission.    The  Informal  PEB  (IPEB)  adjudicated  dermatographic 
urticaria as unfitting rated 10%.  The condition was determined to have existed prior to service 
(EPTS)  and  a  0%  reduction  was  made.    The  CI  appealed,  requesting  the  addition  of 
posttraumatic  stress  disorder  (PTSD)  as  an  unfitting  condition.    A  Reconsideration  PEB 
considered  the  contended  condition  and  determined  no  change  in  the  PEB  findings  was 
required.    The  CI  made  no  further  appeals  and  she  was  medically  separated  with  a  10% 
combined disability rating. 
 
 
CI CONTENTION:  “The medical Board rated only one condition for my discharge: urticaria. I was 
diagnosed with Post Traumatic Stress Disorder (PTSD) as well as anxiety and depression by a 
Naval doctor while on active duty as a result of sexual assault by shipmates in October 2000. 
This condition was not rated by the Medical Board; however it was rated at 30% by the VA.  The 
urticaria I was rated and medically separated for was aggrevated [sic] by the PTSD diagnosed in 
my medical record, but the PTSD was omitted from my rating.  The PTSD made me medically 
unfit  for  duty  on  its  own  and  also  aggravated  my  urticaria  to  require  constant  medication.  
Other service connected conditions include TMJ and Bilateral Pes Cavus, both diagnosed while 
on active duty.”  
 
The CI also attached a letter directed to the PDBR that contained a more detailed history of 
events and the same contentions regarding PTSD. 
______________________________________________________________________________ 
 
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.    The  rating  for  the  unfitting  dermatographic 
urticaria  condition  is  addressed  below.    The  PTSD  as  requested  for  consideration  meets  the 
criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and  is  addressed  below.    The 
temporomandibular  joint  (TMJ)  and  bilateral  pes  cavus  conditions,  and  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 respective Board for Correction of Naval 
Records. 
 
 
 
 

RATING COMPARISON:   
 

Service Reconsideration PEB – Dated 20021016 
Rating 
7199-7118 
10%* 
Rebuttal Considered, 
No Change in Findings 

Condition 
Dermatographic 
Urticaria 
PTSD and Rape 
Trauma** 

Code 

No Additional MEB/PEB Entries 

Combined:  10% 

Condition 

Chronic, Urticaria Pruritis 

Post Traumatic Stress Disorder 
Bilateral Plantar Fasciitis 

5299-5278 
0% X 1 / Not Service-Connected x 2 

Combined:  40% 

VA -   (2 Mos. Post-Separation)  VARD 20030807 (most proximate to 

Date of Separation)   

Code 
7825 

9411 

Rating 
10% 

30% 
10% 

Exam 

20030306 

20030306 
20030306 
20030306 

*Pre Existing Condition - Reduced by 0% 
** Reconsideration PEB considered Psych addendum dated 20020913 and recommended no change in findings to the IPEB. 
 
 
ANALYSIS SUMMARY:  The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System (DES) fitness determinations and rating decisions for 
disability at the time of separation.  The Board utilizes VA evidence proximal 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 only to the 
extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation. 
 
Dermatographic Urticaria Condition.  The CI complained of a history of an “itching rash off and 
on  for  many  years  which  would  develop  into  hives  with  an  itching  rash.”    The  CI  had  been 
treated  with  only  minimal  success  in  the  past  with  numerous  antihistamines  which  included 
Benadryl, Atarax, and Claritin.  The rash worsened considerably during Boot Camp on a nearly 
daily basis.  The CI was initially seen in the emergency room (ER) for hives in September 1998 
with documentation that the hives had occurred on and off for 4 months.  The CI was seen in 
primary care for several visits with complaints of hives and exacerbations at times due to stress.  
The CI was diagnosed with dermatographic urticaria in April 1999.  The CI was seen in the ER in 
September 1999 and the examiner noted that the rash would start as an itching response that 
could develop anywhere on the body and with mild scratching develop into hives which would 
last up to a few hours and either resolve with medication or spontaneously.  The CI continued 
with follow-up for the dermatographic urticaria with primary care from June 1999 through to 
June 2003 with antihistamine treatment.  The CI did not experience any symptoms of difficulty 
breathing or  tongue  swelling  at any  time  with a  hives  episode.    The  CI  underwent  a  Limited 
Duty (LIMDU) Board in October 2001 approximately 15 months prior to separation in which the 
examiner noted that the CI was still complaining of hives being continuous and daily with some 
urticaria noted on her arms and a requirement of antihistamine medications.  As a result of the 
exam, the LIMDU noted that due to the drowsiness side effect of the antihistamines, the CI was 
restricted from any work of a dangerous nature requiring alertness and would need the time to 
get the problem under control with medication so that she could perform sea duty.  The MEB 
examination  6  months  prior  to  separation  indicated  that  the  CI  still  had  poor  control  of  the 
urticaria  on  the  maximum  tolerable  dose  of  antihistamine  medication  and  she  had  failed  to 
make  substantial  progress  in  her  8  months  of  LIMDU.    The  examiner  opined  that  the 
dermatographic urticaria had now persisted in excess of 3 years and was not well controlled on 
medication.    The  VA  Compensation  &  Pension  (C&P)  examination  performed  3  months  after 
separation indicated worsening of the urticaria in response to the stress from the PTSD that 
developed subsequent to a rape in 2000.  The urticaria worsened in response to the stress or 
hot  weather  which  caused  breakthrough  itching  and  urticaria  and  this  caused  the  CI  to  lose 
about  12  days  from  work  in  the  prior  6  months.    Treatment  had  been  limited  to  oral 
antihistamines,  such  as Benadryl,  Singulair,  and Zyrtec,  no  steroid therapy  was  ever  initiated 
during  her  time  in  the  Navy.    At  the  time  of  this  examination,  the  CI’s  symptoms  were 
controlled with medication except when she experienced a PTSD anxiety attack or when the 

2                                                           PD1200884 

weather  is  very  hot.    She  was  experiencing  fatigue  because  of  her  medication  and  had  lost 
about 12 days of work in the previous 6 months.  Her skin examination was normal without 
hives or rashes.  She had never used oral steroids. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  coded  the  dermatographic  urticaria  condition  as  7199  analogous  to  7118  angioneurotic 
edema rated 10% (Attacks without laryngeal involvement lasting one to 7 days and occurring 2 
to 4 times a year).  The PEB determined the condition to be EPTS and reduced the disability 
rating by 0%.  The VA coded the chronic, urticaria pruritis coded 7825 urticaria and rated at 10% 
for  recurrent  episodes  occurring  at  least  4  times  during  the  past  12-month  period,  and; 
responding to treatment with antihistamines or sympathomimetics. 
 
The  Board  must  first  evaluate  the  PEB’s  EPTS  determination.    The  Board’s  authority  for 
recommending  a  change  in  the  EPTS  determination  is  not  specified  in  DoDI  6040.44,  but  is 
considered adjunct to its DoD-specified obligation to review fitness adjudications.  While the CI 
did report a history of pruritus prior to service, there is no indication in the record that this 
condition  ever  reached  the  level  of  symptoms  reported  near  the  time  of  separation  from 
service.    The  CI’s  military  entrance  physical  documents  a  normal  skin  examination  and  no 
diagnosis of any skin disorder.  With no apparent degree of disability at the time of entrance 
into  naval  service, 0%  is  appropriately  deducted  from  the disability  rating  determined  at the 
time of separation. 
 
The Board reviewed the criteria for 7825 and considered the CI’s history of chronic urticaria and 
the need for daily medications to control this condition.  The Board was unclear as to why the 
PEB used the coding 7199 analogous to 7118.  The CI did not have any documented episodes of 
angioneurotic edema.  Although the at the time of the C&P exam, the CI contended that the 
urticaria  had  worsened  and  was  service  aggravated,  there  is  no  evidence  in  the  record  to 
document that steroids were required or a consult with dermatology was needed for additional 
treatment  recommendations;  the  CI  was  continued  on  her  antihistamine  treatment.    After 
much  discussion,  the  Board  decided  that  the  coding  of  7825  chronic,  urticaria  pruritis  more 
accurately  described  the  CI’s  condition.    The  Board  deliberated  on  the  natural  history  and 
potential  service  aggravating  factors  for  the  worsening  of  the  dermatographic  urticaria 
condition.  However, both coding options result in the same disability rating and neither option 
offers any advantage to the CI.  After due deliberation in consideration of the totality of the 
evidence, the Board concluded that there was insufficient cause to recommend a change in the 
PEB adjudication for the dermatographic urticaria condition. 
 
Contended PEB Conditions.  The contended condition adjudicated as not unfitting by the PEB 
was  PSTD.    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. 
 
The  CI  was  not  granted  LIMDU  for  this  PTSD  condition;  it  was  not  implicated  in  the 
commander’s  statement;  and  it  was  not  judged  to  fail  retention  standards.    The  PTSD  was 
reviewed by the action officer and considered by the Board.  There was no indication from the 
record that this  condition significantly interfered with satisfactory duty performance.  The CI 
was  diagnosed  in  October  1999  for  adjustment  disorder  with  depressed  mood  vs.  medical 
problem.  After the rape assault, the CI was followed by mental health clinic and found fit for 
duty throughout each visit in 2001.  The November 2001 psychology note documented that the 
CI was functioning well and there was no indication of significant psychopathology and that the 
CI  was  fit  for  full  duty.    The  MEB  psychiatric  addendum  examination  4  months  prior  to 
separation indicated that there were some active PTSD including thoughts of rape, fear of large 
groups of strangers, fatigue and irritability, however the CI was recently married and reported 

3                                                           PD1200884 

that  her  symptoms  were  in  almost  complete  remission  during  the  time  surrounding  her 
wedding.  The examiner further documented that the symptoms never necessitated removal 
from full duty status or use of psychotropic medications.  The Global Assessment of Functioning 
(GAF) was 65 (some mild symptoms).  The C&P examination 2 months after separation noted a 
GAF 60 (moderate symptoms). 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB noted that the PTSD and rape trauma condition was reconsidered because of a rebuttal by 
the  CI  to  the  IPEB;  however,  there  was  no  change  in  the  findings.    The  VA  coded  the  PTSD 
condition  9411  and  rated  30%.    The  CI  was  evaluated  several  times  by  both  psychology  and 
psychiatry and each time, she was found to be fit for full duty.  At no time was the CI given a 
LIMDU  for  a  mental  health  condition.    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 PTSD contended condition and 
therefore, no additional disability rating 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.    In  the  matter  of  the 
dermatographic  urticaria  condition  and 
IAW  VASRD  §4.104,  the  Board  unanimously 
recommends  no  change  in  the  PEB  adjudication.    In  the  matter  of  the  contended  PTSD 
condition, the Board unanimously recommends no change from the PEB determinations 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:   
 

Dermatographic Urticaria 

UNFITTING CONDITION 

VASRD CODE  RATING 
7199-7118 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120610, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 
 
 

 

X 
Acting Director 
Physical Disability Board of Review 

4                                                           PD1200884 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW  
                                        BOARDS  

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

Ref:   (a) DoDI 6040.44 

             (b) CORB ltr dtd 04 Apr 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR 
that the following individual’s records not be corrected to reflect a change in either characterization 
of separation or in the disability rating previously assigned by the Department of the Navy’s 
Physical Evaluation Board: 
 
 
 
 
 
 
 
 
 
 
 
 

-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
  
 

 
 
 
 
 
 
 
 
 
 
 

 

 

     
 
 
 
 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  x 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

5                                                           PD1200884