RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01292
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20090112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Personnel Specialist, medically separated for “left lower extremity post-phlebitic syndrome” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact daily activities.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 PEB - 20080918	VARD - 20090324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Lower Extremity Post-Phlebitic Syndrome	7121	10%	Post Phlebitic Syndrome Status Post Deep Vein Thrombosis, Left Lower Extremity	7121	10%	20081119	
Left Lower Extremity Deep Venous Thrombosis	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Lower Extremity Post-Phlebitic Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM)), the CI’s left leg condition began in April 2007. Radiographic studies showed venous thrombosis (clot) involving the left femoral vein to the popliteal vein.  The CI was treated with anticoagulation (blood thinning) therapy.  Follow-up radiographic studies demonstrated a patent (open blood flow) at the site of the prior clot.  
A vascular surgery evaluation in April 2008 noted physical findings of chronic swelling in both lower extremities.  At a hematology evaluation in August 2008 the examiner noted that the CI’s hypercoagulable workup was negative for any predisposition for clotting.  Upon completion of anticoagulation therapy, the CI had a second thrombosis in August 2008 at the same site. He was treated with another course of anticoagulation therapy and maintained on anticoagulation medication.  

The NARSUM physical examination demonstrated pedal (foot) edema bilaterally; left greater than right.  The cardiac and lung examinations were normal.  

At the VA Compensation and Pension (C&P) examination performed 2 months after separation, the CI reported left leg pain with prolonged standing and walking  He reported swelling which was nor relieved by elevation or compression hosiery.  He reported continued use of Coumadin for anticoagulation.  On physical examination there was dark pigmentation of the skin, eczema, and 2+ edema (swelling) in the left lower extremity.  The examiner noted that elevated edema was present.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the left lower extremity post-phlebitic syndrome condition 10% (coded 7121, Post-phlebitic syndrome of any etiology).  Board member noted that multiple treatment notes and the NARSUM and VA examinations documented chronic left lower extremity edema.  The NARSUM examination did not address stasis pigmentation, however, the VA examination documented stasis pigmentation and eczema with reported of intermittent ulceration.  Board members agreed that the evidence supports a 40% rating (persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the left lower extremity post-phlebitic syndrome condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that left lower extremity deep venous thrombosis was related to the unfitting condition.  The totality of the evidence was reviewed and considered by the Board.  Board members noted that the post-phlebitic syndrome was a residual of the venous thrombosis; however there was no radiographic evidence of an active thrombotic event (clotting) at the time of separation.  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 Category II determination for the left lower extremity deep venous thrombosis contended condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left lower extremity post-phlebitic syndrome condition, the Board unanimously recommends a disability rating of 40%, coded 7121 IAW VASRD §4.104.  In the matter of the contended left lower extremity deep venous thrombosis conditions, the Board unanimously recommends no change from the PEB determination as Category II.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Lower Extremity Post-Phlebitic Syndrome	7121	40%	
RATING	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140225, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 15 Apr 16 ICO XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 09 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXX 
	(i) PDBR ltr dtd 14 Apr 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 
     
     i. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 70 percent disability rating (increased from 10 percent) effect date of discharge.
 
     j. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.       

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)