RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00736
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 0-3 (Preventive Medicine) medically separated for bilateral deep vein thrombosis.  The thrombosis could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Bilateral deep venous thrombosis with post-phlebitic syndrome was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (see rating chart below) as not disqualifying for PEB adjudication.  The Informal PEB adjudicated bilateral deep vein thrombosis w/post-phlebitic syndrome as unfitting, rated 20% (10% for each leg), with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI appealed to the Formal PEB but withdrew appeal.  He made no further appeal and was medically separated.

CI CONTENTION:  The CI contends that all of his MEB conditions be considered unfit and rated. The applicant’s complete submission is at Exhibit A.

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 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

IPEB - Dated 20070829	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Deep Vein Thrombosis with Postphlebitic Syndrome	7120	10%	Deep Vein Thrombosis	7121	20%	20071128	
Right Deep Vein Thrombosis with Postphlebitic Syndrome	7120	10%					
Asymmetric High Frequency Hearing Loss and Tinnitus, Right Ear	Not Unfitting	Persistent Tinnitus, Right Ear	6260	10%	20071121	
		Right Ear Hearing Loss	6100	NSC	20071121	
Arnold Chiairi I Malformation	Not Unfitting	Arnold Chiairi Malformation	8009-8003	0%	20071128	
Erectile Dysfunction	Not Unfitting	Erectile Dysfunction	7522	NSC	20071128	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20080122 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Bilateral Deep Vein Thrombosis with Postphlebitic Syndrome.  The CI was admitted and treated for bilateral iliofemoral vein thrombosis (formation of a blood clot [thrombus] within deep veins in his legs] on 15 March 2006.  After his discharge he was maintained on Coumadin therapy for anticoagulation.  An evaluation by vascular surgery dated 22 May 2006 noted persistent, significant bilateral leg sealing and pain which decreased with the use of compression stockings.  Physical findings of the presence of compression stockings without stasis changes, edema, or lower extremity tenderness to palpation were noted on DD Form 2808, Report of Medical Examination.  A vascular surgery note dated 27 June 2007 noted physical findings of localized brownish discoloration indicative of bilateral stasis pigmentation of the feet and ankles.  The examiner noted that the CI was wearing compression stockings and the absence of edema. A diagnosis of post-phlebitic syndrome was rendered.

At the VA Compensation and Pension (C&P) examination performed 2 months before separation, the CI reported leg pain with prolonged standing and walking; intermittent edema relieved by foot elevation or compression hosiery; and continued use of anticoagulation medication.  On physical examination there was hyperpigmentation at the heels; no ulcerations or edema, and decreased below the knee pulses bilaterally.  The gait was normal.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral deep venous thrombosis with post-phlebitic syndrome at 10% for each leg, coded 7120 (Varicose veins).  VA rated the bilateral condition at 20%, coded 7121 (Post-phlebitic syndrome of any etiology [cause]).  The Board considered whether the evidence supported a higher than 10% rating for each lower extremity.  The Board placed higher probative value on the VA examination because it was most proximate to separation.  Board member agreed that the VA history and physical examination findings met criteria for a 10% rating.  The evidence did not support a higher rating for persistent edema incompletely relieved by elevation.  Considering the totality 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 left or right deep vein thrombosis with postphlebitic syndrome.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that asymmetric high frequency hearing loss and tinnitus right ear, Arnold Chiari I malformation, and erectile dysfunction conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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 any of the contended conditions and so no additional disability ratings are 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 bilateral deep venous thrombosis with post-phlebitic syndrome condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended asymmetric high frequency hearing loss and tinnitus right ear, Arnold Chiari I malformation, and erectile dysfunction conditions, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160002362 (PD201400736)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA