RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-02890
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141118
SEPARATION DATE:  20070705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (AFS 3E052/Electric Power Production Craftsman) medically separated for a protein deficiency.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB).  The deficiency condition, characterized as “coagulopathy, protein c deficiency,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “coagulopathy, protein C deficiency, with history of deep vein thrombosis” as existing prior to service (EPTS).  The CI appealed to the Formal PEB (FPEB) and Secretary of the Air Force Personnel Council, but the FPEB subsequently found the condition unfitting, rated at 0% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no further 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting coagulopathy (Protein C deficiency) condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.   Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service Reconsideration PEB – Dated 20070504	VA - (4.4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coagulopathy, Protein C Deficiency, with History of Deep Vein Thrombosis	7199-7121	0%	Thrombophlebitis of Popliteal Vein, Left Leg	7121	NSC*	20070223	
Other x 0  (Not in Scope)	Combined:  40%	
Rated:  0%		
Derived from VA Rating Decision (VARD) dated 20070802.
* Rated left lower extremity…protein C deficiency at 20% effective 20070706 (VARD 20100127)

ANALYSIS SUMMARY:

Coagulopathy, Protein C Deficiency, with History of Deep Vein Thrombosis Condition.  The narrative summary notes the CI was diagnosed with a hereditary coagulopathy disorder (protein C deficiency) following a deep vein thrombosis (DVT) of the left lower extremity (LLE) in December 2005.  Notes in the service treatment record indicated that the CI had a similar episode of swelling and pain in the right LE in August 2005, but the ultrasound was interpreted as normal.  Following the LLE DVT, based on the history of DVT, likely recurrent and the coagulation disorder, it was recommended that the CI stay on life-long anticoagulation.  The CI was admitted to the hospital for evaluation of chest pain and shortness of breath on 8 January 2006; heart attack and pulmonary embolism (blood clots to the lungs) were both ruled out.  At the MEB examination performed on 10 December 2006 (approximately 8 months prior to separation), the CI reported no concerns, other than the noted anticoagulation therapy.  The MEB physical examination did not note any varicosities, swelling, induration, redness, warmth, discoloration, or dermatitis of either LE.  Laboratory studies indicated abnormal levels of Protein C activity.

At the VA Compensation and Pension examination on 23 February 2007 (approximately 4 months after separation), the CI reported thrombophlebitis of the left leg.  On examination of the bilateral LE pulses, strength, sensation, and reflexes were normal and there was no swelling, ulceration, or dermatitis.  The examiner indicated that the thrombophlebitis of the left leg was resolved.

The Board directed attention to its rating recommendation based on the above evidence.  The FPEB adjudicated the coagulopathy as EPTS, without permanent service aggravation coded 7199-7121 (post-phlebitic syndrome of any etiology).  The CI appealed to the Secretary of the Air Force Personal Council, which found the condition was not EPTS, due to the development of symptoms which may have been contributed to by military activities.  The coagulopathy condition was found unfitting, coded 7121, rated at 0%.  The original VARD did not service-connect the “thrombophlebitis of popliteal vein, left leg.”  The VARD dated 28 May 2009 indicated that a “clear and unmistakable error” had occurred and service-connected “Protein C deficiency with deep venous thrombosis of the left lower extremity,” rated at 0%, noting that the DVT had resolved, but anticoagulation was still required.  The Board agreed that the evidence in record met the 0% rating IAW §4.104 (cardiovascular system), coded 7199-7121, specified as asymptomatic visible or palpable varicose veins and does not achieve the next higher rating of 10%, specified as intermittent edema of the legs or aching and fatigue after prolonged standing or walking, with symptoms relieved by elevation or compression stockings.  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 coagulopathy 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 coagulopathy condition and IAW VASRD §4.104, 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 20140612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAF/MRB

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-02890.

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,

Attachment:
Record of Proceedings