RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04013
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20091117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, Basic Trainee, medically separated for “post phlebitic syndrome, left upper extremity (LUE),” with a disability rating of 20%. 

CI CONTENTION:  “Please consider all conditions. Right arm, left arm (impairment), actually with both combined.”  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 – 20091105	VARD – 20100225/20101104  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Phlebitic Syndrome LUE	7121	20%	DVT of Left Arm….	7199-7121	10%	20100125	
			Prothrombin II Deficiency…	6399-6350	10%	20101029	
RATING:  20%	RATING:  10%	

ANALYSIS SUMMARY:  

Phlebitic Syndrome Left Upper Extremity.  The record shows that the CI presented to the emergency room (ER) on 10 June 2009 with a history of 5 days of pain and swelling of the LUE after participation in an obstacle course.  He was admitted to the hospital for a deep venous thrombosis (DVT) and placed on an anti-coagulant.  During the evaluation, he was found to have a genetic mutation with a secondary Prothrombin II deficiency.  As a consequence, the CI was hypercoagulable (easy blood clotting, the opposite of a hemophiliac).  An evaluation for other etiologies of the clotting disorder was negative.  Lifelong anti-coagulation was recommended, which is not compatible with military service.  
The Medical Evaluation Board (MEB) evaluations were accomplished on 1 July 2009 and noted that the CI remained on an anti-coagulant.  On examination, the LUE was swollen and tender.  Sensation and hand strength were reduced.  The narrative summary (NARSUM) was dated 21 August 2009, 3 months prior to separation.  It was noted that swelling of the LUE was reduced, but persisted from the armpit to the mid-forearm.  The pulses were intact as was the neurological examination.  At the VA Compensation and Pension (C&P) examination performed on 25 January 2010, 2 months after separation, the CI reported that he did lifting and carrying in his occupation and that this aggravated his LUE pain and swelling.  On examination, the LUE was slightly swollen, but the pulses and neurological examination were normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the post-phlebitic syndrome LUE at 20%, coded 7121 (post-phlebitic syndrome).  The VA rated the condition at 10%, using an analogous code 7199-7121.  It later raised the rating to 20% based on a C&P dated 29 October 2010.  A higher 40% rating requires stasis pigmentation or eczema, neither of which were recorded.  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 fitness determination for the post-phlebitic syndrome LUE condition.  

BOARD FINDINGS:  In the matter of the post-phlebitic syndrome LUE 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.  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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20160013813 (PD201404013)

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