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AF | PDBR | CY2013 | PD-2013-01344
Original file (PD-2013-01344.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01344
BRANCH OF SERVICE: Army  BOARD DATE: 20141106
SEPARATION DATE: 20040722


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active National Guard SPC/E-4 (68B10/Turbine Engine Mechanic) medically separated for lupus. The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “discoid lupus erythematosus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated “discoid lupus erythematosus” as unfitting, rated 10%. The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB finding and rating and h was medically separated.


CI CONTENTION: The CI attached a three page statement to his application which was reviewed by the Board and considered in its recommendations.


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 lupus condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service FPEB – Dated 20040625
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Discoid Lupus Erythematosus 7809-7806 10% Discoid Lupus Erythematosus 7809-7806 10% 20040927
Other x 0 (Not in Scope)
 Other x 1
Rating: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 50405 (most proximate to date of separation)


ANALYSIS SUMMARY:

Discoid Lupus Erythematosus. The record indicated the CI during his deployment to Iraq in 2004 developed a rash of the face, neck and trunk after skin exposure to sunlight. He was medevaced for further diagnostic work-up and treatment. The CI underwent evaluations with dermatology, and rheumatology, and had skin biopsies consistent with the diagnosis of discoid lupus erythematosus (DLE). The rash responded well to topical steroid creams, and to preventative measures; however, upon repeat direct skin exposure to sunlight, exacerbations occur. Laboratory tests to evaluate general health and immune status were negative (ANA, rheumatoid factor, Urine, renal and liver function). Rheumatology consult dated 20 April 2004 ruled out systemic lupus. Examination of the skin revealed a faint, confluent macular rash on the cheeks and behind the ears. The CI reported pain in the knees, right hip, low back, and right shoulder/neck, and fatigue. The physician recommended continued use of topical steroid and consideration of possible immunosuppressant medication. The MEB narrative summary on 7 May 2004, noted the CI used topical steroid creams and took non-steroidal anti-inflammatory medications. Physical examination recorded the absence of rash, and no signs of edema or swelling of the joints. The physician noted a bone scan was performed that indicated the absence of autoimmune disease. The physician opined the problem was solely related to sun exposure, he had minor flare-ups when exposed to “too much sun.” Therefore, returning to desert areas would likely result in flare-ups, and for that reason, the code “M” for high environmental temperature was merited, effectively disqualifying the CI for deployment. A letter from the treating dermatologist dated 8 July 2004 noted the CI had only limited involvement of his skin disease; however, he had a recent flare (approximately 30-35% body surface area [BSA]) of his cutaneous lupus after working outside in his yard on a sunny day. A “multi-week” prednisone course was required to bring his disease under control.

The VA Compensation and Pension examination on 27 September 2004 (approximately 2 months after separation), noted the presence of a small rash of about one-two inches diameter, midline chest, and on “most” of the dorsal aspect of the left arm/forearm, as well as about half of “that quantity” on the right arm/forearm. The rash on the arms/forearm was described as less than one half inch diameter, in a scattered pattern of distribution. The physician opined the rash in totality covered between 5% and 9% of BSA. There was no absence of underlying tissue and no evidence of skin atrophy. Examination of the joints demonstrated full range-of-motion in all joints, with no signs of inflammation.

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the DLE condition at 10% analogously coded 7809-7806. The PEB initially assigned a 0% rating based on exposure restrictions. The CI non-concurred and wrote a letter that stated his wish to remain on active duty, to deploy and use adequate sunscreen to protect against exposure. The CI later developed a rash and the FPEB rated the condition at 10%. A rating of 30% requires evidence of dermatitis or eczema involving 20-40% of the entire body or 20-40% of exposed areas affected; or systemic therapy for a total duration of 6 weeks or more, but not constantly, during the past 12-month period. The Board considered the letter submitted by the treating dermatologist dated 2 weeks prior to separation. The physician stated the CI required “multi-week” prednisone therapy, did not define the number of weeks. The rash covered “approximately 30-35% of SBA,” and had come under control. There was no description of the rash in regards to areas of distribution, appearance, time of occurrence, or length of duration. The Board concluded the letter had low probative value. The Board noted oral steroids were not part of his treatment regimen even at the time of medical evacuation. The CI only had flare-ups when there was skin exposure to sunlight. Covered skin was not susceptible to rash. All Board members agreed the 30% rating was not supported by the evidence. After due deliberation, considering all of the evidence and mindful of the VA Schedule for Rating Disabilities (VASRD) §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the DLE 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 DLE condition and IAW VASRD §4.88b, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130910, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150006428 (PD201301344)


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 of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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