RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02587
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Military Police) medically separated for deep vein thrombosis (DVT).  The DVT condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  A profile allowed for an alternate aerobic event to satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “recurrent deep vein thrombosis,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “recurrent deep vein thrombosis, right lower extremity on chronic anticoagulation” as unfitting, rated 0%, citing application of the Department of Defense Instruction (DoDI) 1332.39.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions.”  

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/Naval 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:  

IPEB – Dated 20030401	VA* - (~1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DVT	7199-7120	0%	Thrombosis Distal Femoral and Popliteal Vein Right Leg	7120	10%	20030603	
Other x 0 (Not In Scope)	Other x 6	
RATING:  0%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20030826 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:

Deep Vein Thrombosis Condition.  The CI developed a DVT (blood clot) in the right lower leg in May 2001 and was treated for several months with anticoagulation medication.  After a recurrence in the same leg in January 2002, lifelong anticoagulation medication was instituted.  At the MEB exam on 2 December 2002 (7 months prior to separation) the CI reported numbness and tingling of the lower leg in the area of the previous blood clot.  Physical exam showed tenderness of the posterior distal third of the leg but no leg edema (swelling).  The narrative summary (NARSUM) on 2 January 2003 (6 months prior to separation) reported an inability to engage in certain activities due to risks associated with his condition.  Physical exam noted numerous varicosities of the right lower extremity; one tender varicosity was present behind the knee.  There was no edema of the extremity, and gait was normal.  The CI presented on 20 January 2003 with another right leg DVT in the context of inadequate anticoagulation, requiring a two day hospitalization for medication management.  Follow-up on 5 February 2003 noted the persistence of some leg swelling due to the recent DVT.  In April 2003 (3 months prior to separation) the CI was treated with topical medication for a suspected allergic-related right leg skin problem.  At medication follow-up appointments in April and May 2003 the CI denied extremity swelling.

At the VA Compensation and Pension exam performed a month before separation, the CI reported right leg pain at rest and after prolonged standing or walking; edema also occurred after prolonged standing or walking and was not completely relieved by elevating the foot or by compression stockings.  He also complained of dark pigmentation of the skin and eczema.  Examination showed mild edema of the right lower extremity.  Stasis skin pigmentation was also noted but eczematous changes were absent.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating (“asymptomatic palpable or visible varicose veins”) under an analogous 7120 code (varicose veins).  The VA’s 10% rating was based on the same code for “intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery.”  In deliberating a rating recommendation, Board members considered that the VA examiner reported mild edema, but most service providers reported no edema.  This symptom was therefore considered to be intermittent, and not the “persistent” stipulation required for the higher 20% or 40% ratings.  The Board debated the VA examiner’s report of mild edema and reported leg pain in contrast to the NARSUM examiner’s report of visible varicosities, one of which was tender. The Board concluded that the evidence just described was best depicted by the 10% rating criteria.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the recurrent deep vein thrombosis 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.  As discussed above, PEB reliance on DoDI 1332.39 for rating recurrent deep vein thrombosis was operant in this case and the condition was adjudicated independently of that instruction by this Board.  In the matter of the recurrent deep vein thrombosis right lower extremity condition, the Board unanimously recommends a disability rating of 10%, coded 7199-7120 IAW VASRD §4.104.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Recurrent Deep Vein Thrombosis Right Lower Extremity 	7199-7120	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160003820 (PD201402587)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA