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AF | PDBR | CY2013 | PD-2013-02232
Original file (PD-2013-02232.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02232
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20141216
SEPARATION DATE: 20021130


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Rifleman) medically separated for a skin condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was placed on limited duty and eventually referred for a Medical Evaluation Board (MEB). The MEB characterized the CI’s skin condition as “solar urticaria” (a condition in which exposure to the sun [or ultraviolet radiation] induces urticaria or hives) and forwarded this to the Physical Evaluation Board (PEB) for consideration. No other conditions were submitted by the MEB. The PEB adjudicated the solar urticaria as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “My condition is not treatable. I can’t be out in the sun for too long. I have solar urticaria. I also had surgeries on my right middle finger and PTSD [posttraumatic stress disorder]. With my condition it’s hard for me to do outside activities such as yard work, exterior work on my house and most of all play outside with my children. That increases my PTSD levels. Also the surgeries I had on my right middle finger has had an impact on my work abilities too. It seems that my PTSD gets worth everyday.” [sic]


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20021002
 VA - (2 Wks. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Solar Urticaria 7899-7806 10% Solar Urticaria 7825 10% 20021112
Other x 0 (Not In Scope)
 Combined: 30%
Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30116 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Solar Urticaria. The narrative summary (NARSUM) notes that the CI did well until November 2001 (11 months prior to separation) when he developed a rash “severe skin eruption” while on deployment in Pakistan. He was tried on several medications including antihistamines and a 5-day course of Prednisone (a steroid, which constitutes immunosuppressive therapy) without relief and became aware that the rash would only occur after being exposed to sunlight for several minutes. A dermatology note stated that his rash lasted 3 hours after sun exposure. He did not have any systemic symptoms such as nasal or respiratory problems. After an extensive workup he was diagnosed with solar urticaria. He did not respond well to further treatment regimens (multiple antihistamines and montelukast, a leukotriene inhibitor, which does not qualify as systemic immunosuppressive therapy) and it was determined that his severe chronic symptoms with sunlight exposure significantly hindered his ability to perform his duties. Careful review of the available treatment record indicated that the CI was prescribed a single 5-day course of steroids (Prednisone) soon after the development of his symptoms in 2001, but received no other systemic immunosuppressive therapy after that. At the NARSUM exam 4 months prior to separation, the CI was on antihistamines including montelukast, and had no urticarial (skin rash/hives) lesions on examination. The CI reported “no significant improvement of his episodes, regularly getting urticarial lesions within 20-30 minutes of being exposed to sunlight.” At the MEB exam 3 months prior to separation, the CI was asymptomatic and was on antihistamines and montelukast. He was noted to have a normal skin exam (except for scars and tattoos). Neither of these two examinations mentioned any specific treatment with systemic immunosuppressive therapy.

The VARD stated: “VAE [Veterans Administration Examination, conducted approximately 2 weeks prior to separation] found no evidence of skin rash, urticaria or hives.” Review of the treatment record and the VA findings did not show evidence of recurrent debilitating episodes that required intermittent systemic immunosuppressive therapy for control. Review of subsequent VARDS (up to 28 October 2013) showed no additional history or change in the disability rating.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the solar urticaria with analogous code 7806 (Dermatitis or eczema) at 10% (VARD criteria: [based on the percentage of skin or exposed skin affected by the urticaria], or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than 6 weeks during the past 12-month period). The VA rated the condition with code 7825 (Urticaria) at 10% (VARD criteria: Recurrent episodes occurring at least four times during the past 12-month period and; responding to treatment with antihistamines or sympathomimetics). Since the CI had no rash at all disability examinations, and had been treated with a single 5-day course of Prednisone, the Board determined that a 10% rating was appropriate, using either code 7806 or 7825. Because the CI did not have an active rash, did not suffer recurrent debilitating episodes, and did not require corticosteroids or other immunosuppressive therapy for control, a higher rating was not supported. 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 solar 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 solar urticaria 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131006, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Records








                          
XXXXXXXXXXXXXXXXXXXX, DAF
President
DoD Physical Disability Board of Review



 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
 Subj:    PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CO RB ltr dtd 13 May 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX , former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX , former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USN






XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)

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