RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03736
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “Raynaud’s Phenomenon" with a disability rating of 20%.  

CI CONTENTION:  The CI requests all conditions be considered.  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 based upon a 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 - 20070627	VARD - 20071116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud’s Phenomenon…	71117	20%	Reynaud’s Phenomenon	7117	20%	20070926	
Anxiety Disorder	Not Unfitting	Anxiety Disorder, Not Otherwise Specified	9413	100%	20071011	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Raynaud’s Phenomenon.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had bilateral hand cold weather injuries in December 1995.  In 2004 the CI started having pain in his fingers, and bilateral hand pain and finger pain worsened with noted discoloration.  Rheumatology evaluation in October 2005 indicated the CI’s clinical picture was of Raynaud’s phenomenon.  Despite treatment, the bilateral hand Raynaud’s condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “Raynaud’s Phenomenon” for PEB adjudication.   
The MEB NARSUM examination on 27 December 2006, 7 months prior to separation, noted complaints of intermittent numbness, paresthesias, pain and white discoloration of fingers bilateral hands consistent with Raynaud's phenomenon, causing intermittent discoloration, cooling and loss of dexterity to fingers and difficulty gripping.  

Symptoms were intermittent, in no particular pattern except usually associated with cold weather.  Symptoms also occasionally happened in warmer environment.  Symptoms last from 15 minutes to 45 minutes at a time and several times a day particularly, again in cold weather.  The CI had “episodes approximately 3-4 days per week.”  Physical examinations had shown a provided witnessed episode of white discoloration and coldness noted in the patient's fingertips of both hands on at least one clinical visit.  The examiner indicated that finding was on an intermittent basis.  

At the 26 September 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported episodes of bilateral hand and finger pain with discoloration, paresthesias, weakness, and numbness.  Attacks were usually caused by temperature changes and cold weather.  The CI had attacks four to six times a week, with a duration of more than 60 minutes.  Physical exam showed no impaired strength or dexterity of either hand.  Fingers were “cool and more pale than normal compatible with Raynaud’s.”  The diagnosis was Raynaud’s and the effects were “he cannot work in a cold environment. Otherwise he can do a physical or sedentary employment in a warm environment.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Reynaud’s Phenomenon condition 20%, coded 7117 (Raynaud’s syndrome), citing (symptoms) an average of 3-4 days per week.  The VA also rated the Reynaud’s Phenomenon condition 20% coded 7117, based on the VA C&P examination 2 months after separation, citing characteristic attacks occurring four to six times a week.  The Board considered all of the evidence of record and there was insufficient evidence of “characteristic attacks occurring at least daily” for any rating higher than that awarded by the PEB and VA.  

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 Raynaud’s phenomenon condition.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that anxiety disorder was not unfitting.  The anxiety disorder was not profiled, implicated in the commander’s statement or judged to fail retention standards.  The psychiatry NARSUM addendum dated 13 March 2007, 4 months prior to separation, indicated the CI had been treated since May 2005 for anxiety symptoms secondary to pre-deployment psychosocial stressors related to family care.  During deployment, the CI “experienced significant anxiety within the context of occupational stress and interpersonal issues with a senior NCO.”  He was evacuated for psychiatric stabilization and a brief hospitalization.  The CI was treated with medications and psychotherapy and had not attempted to harm himself or others.  The mental status examination was notable only for a mood that was “anxious at times” and a mildly anxious affect.  There was no active suicidal ideation, delusional or hallucinatory symptoms, or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The diagnosis was anxiety disorder not otherwise specified (NOS), with military impairment in the moderate range and social and industrial impairment in the mild to definite range.  Global assessment of functioning was 70 (in the mild symptom range).  The psychiatrist recommended an S2 profile, and stated there were no duty limitations due to the CI’s psychiatric condition and the condition was medically acceptable.  The CI continued to attend Interpersonal Group sessions through July 2007 without note of significant mental health difficulties.  

The commander’s statement indicated that the CI’s duty performance was outstanding, but could only perform duties in garrison due to profile restrictions relating to outdoor temperature restrictions.  There was no performance-based evidence from the record that the anxiety disorder significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 anxiety disorder condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the Reynaud’s Phenomenon condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  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 20140802, 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 
XXXXXXXXXXXXXXXXXX, AR20160017212 (PD201403736)

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