RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00120
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Specialist, medically separated for “bilateral lower extremity valvular insufficiency,” with a disability rating of 10%.  

CI CONTENTION:  The VA rated him higher for his unfitting conditions.   The applicant’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 - 20011228	VARD - 20031217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Valvular Insufficiency	7199-7120	10%	Varicose Veins Left Leg	7120	10%	20030916	
			Varicose Veins Right Leg	7120	10%	20030916	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Lower Extremity Valvular Insufficiency.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had longstanding painful varicose veins in both legs.  Venous imaging and ultrasound confirmed valvular insufficiency of the veins of both lower extremities and general surgery indicated dense varicosities on both legs.  Due to increasing pain in the lower legs he underwent bilateral saphenous vein stripping in February and July 2000, with a more difficult recovery on the right leg.  There was marked improvement in appearance after surgery; however, bilateral lower extremity pain persisted with pain on prolonged standing and increased pain on physical exertion.  The CI was completely unable to run and used compression hose (TED hose) to decrease his leg pain.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated July 2001, 8 months prior to separation, physical examination showed lower extremity edema, varicosities, and mottling without sensory deficits.  At the NARSUM examination dated September 2001, 6 months prior to separation, the CI reported bilateral varicose veins with pain on prolonged standing and increased pain on physical exertion.  The NARSUM physical examination stated:  “The (CI) remains with significant varicosities in both lower extremities, hyperpigmentation of the skin, and well-healed surgical scars on both sides.  At the end of the day with prolonged standing, he has marked pretibial edema on both sides.”  

At the VA Compensation and Pension (C&P) examination in September 2003, performed 18 months after separation, the CI reported a similar history bilateral leg surgery for varicose veins.  He complained of pain that occurred after prolonged standing, walking and running; constant edema that was not relieved with foot elevation or compression hosiery; dark pigmentation of the skin; and frequent itching, without any ulceration.  Physical examination showed bilateral edema of 2-3+ without elevated edema, varicose veins were absent and there was no ulceration.  There was stasis pigmentation bilaterally.  Eczema was absent and posture and gait were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 7120 code (varicose veins), citing bilateral vein stripping with an improvement in condition; continued pain with prolonged standing and physical; and bilateral pretibial edema at the end of the day.  The VA assigned a separate 10% rating to each leg using the 7120 code based on the VA C&P examination 18 months after separation, citing no varicose veins found in either leg, with edema (relieved with elevation of the leg) and stasis pigmentation on both legs with no eczema or skin ulceration noted.  Diagnostic code 7120 has a note specifying that the evaluation is for involvement of a single extremity and that “if more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.”  

The Board, IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral lower leg adjudications; although, each leg must be reasonably justified as unfitting for separate disability ratings.  In this case, both legs were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; and, both were profiled.  Members agreed that the evidence of the record reasonably supported that each leg was separately unfitting; and, that coding and rating features were essentially identical.  

The Board considered that all service examinations documented symptomatic bilateral varicose veins with stasis pigmentation without eczema or ulceration.  The MEB examination indicated bilateral edema, but did not evaluate if it resolved with elevation or compression, while the NARSUM examination did not specify presence or absence of edema, but stated that the CI indicated edema at the end of the day.  The VA examination indicated that there were no varicose veins, but there was stasis pigmentation and specified that there was edema “without elevated edema” [relieved by elevation of extremity - not persistent].  The Board focused on the criteria of intermittent or persistent edema with stasis pigmentation and deliberated between the 10%, 20% and 40% rating criteria extracted below:  

7120 Varicose veins: [extracted]
Persistent edema and stasis pigmentation or eczema, with or without 
	intermittent ulceration	40
Persistent edema, incompletely relieved by elevation of extremity, 
	with or without beginning stasis pigmentation or eczema	20
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	10

The Board concluded that there was not adequate evidence to support persistent edema at the time of separation.  The Board adjudged that each leg met the 10% criteria under analogous code 7120.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends that each leg be considered separately unfitting with a disability rating of 10% for the left leg and a 10% rating for the right leg condition, each coded 7199-7120.  

BOARD FINDINGS:  In the matter of the bilateral lower extremity valvular insufficiency condition, the Board unanimously recommends that each leg be separately rated with a disability rating of 10% for the left and 10% for the right, each coded 7199-7120 IAW VASRD §4.104.  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, effective as of the date of the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Lower Extremity Valvular Insufficiency	Left	7199-7120	10%	
	Right	7199-7120	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150130, 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 XXXXXXXXXXXXXXXXXX AR20160014220 (PD201500120)

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 20% 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