RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX						            CASE:  PD-2014-01107
BRANCH OF SERVICE:  AIR FORCE	 SEPARATION DATE:  20090626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Dental Lab Craftsman) medically separated for left lower extremity (LLE) lymphedema.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  Lymphedema was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his lymphedema as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I took what was offered to me at the time, I didn't believe I had another choice.  After I had surgery on my lower left extremity (lymphedema) in May 08 and the results were unsuccessful, I was informed by my medical provider and commanders that I would most likely not be able to continue my military career due to my condition.  I then reluctantly took the only option I thought I had which was discharge at 20% (honorable).”

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 20090413	VA* - (~1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lymphedema	7199-7121	20%	Left Leg Edema…	7121	20%	20090519	
Other x 0 (Not In Scope)	Other x 9	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20090813 (most proximate to date of separation [DOS]

ANALYSIS SUMMARY:

Lymphedema.  The first record in evidence for the lower left extremity (LLE) lymphedema (fluid in the soft tissues) condition is a physical therapy (PT) note dated 4 February 2006 in which the CI reported a history of recurrent lymphedema since 1997.  He had been treated with sclerotherapy (injections to reduce the size of the lymph vessels) in 1999, but now had increased symptoms.  He denied any history of antecedent trauma initially, but later reported a sprain in basic training.  On 1 March 2007, he was evaluated in orthopedics and reported that he had recently had the worst episode to date.  He was issued compression hose and a repeat evaluation was recommended.  X-rays of the left ankle were normal and a CT scan of the abdomen and pelvis (looking for a blockage to the lymphatic drainage) on 12 February 2008 was also normal.  A duplex ultrasound (normal ultra sound and a Doppler study) showed superficial venous insufficiency (an incompetence of the venous valves leading to increased pressure in the lower veins and leakage of fluid into the surrounding tissue, lymphedema).  Sclerotherapy was repeated on 14 May 2008 along with LASER ablation (a treatment for varicose veins).  This improved, but did not resolve the soft tissue swelling.  The CI met an MEB in June and was restricted from deployment.  An MRI on 28 July 2008 did not reveal an etiology for the lymphedema.  A bone scan and CT scan also were unremarkable.  An orthopedic note dated 10 September 2008 recorded that the CI was now more symptomatic than prior to his surgery.  He was unable to meet duty requirements and again referred for an MEB.  The MEB narrative summary (NARSUM) was dated 3 November 2008.  It noted persistent lymphedema refractory to treatment.  The CI did use compression stockings.  No skin changes were noted by the examiner other than the lymphedema.  The CI was again seen in primary care on 22 December 2008.  It noted that he could not walk for over 30 minutes and that he was limited to working for a 30 minute period 2-3 times a day.  His LLE examination was remarkable for swelling and tenderness, but other pathology was not recorded.

At the VA Compensation and Pension (C&P) examination performed on 19 May 2009, a month before separation, the CI reported that he continued to use a compression stocking and still had pain and swelling.  The cardiovascular examination was normal as were the distal pulses (although hard to feel due to the swelling).  The soft tissue was noted to be “mildly tense” due to the edema, but there were no “skin complications” and the hair growth was normal (indicative of normal blood flow).

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 fitness determination for the lymphedema 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 lymphedema condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.

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 20140303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01107.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings