RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00663
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Combat  Engineer, medically separated for “Raynaud’s syndrome,” with a disability rating of 10%.  

CI CONTENTION:  “Given a 10% rating @ discharge, but changed on Jul 16, 2012.”  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 – 20020513	VARD - 20030331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud’s Syndrome	7117	10%	Raynaud’s Syndrome	7117	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Raynaud’s Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first manifested symptoms of Raynaud's phenomenon (recurrent finger and toe vasospasm in response to cold or stress) with cold exposure in September 2000.  A chest X-ray to assess for Raynaud’s associated interstitial lung disease was normal.  Bilateral hand X-rays were normal.  Bilateral knee X-rays showed bilateral tibial tuberosity fragmentation (R>L), which can be associated with a clinical diagnosis of Osgood-Schlatter disease ([OSD] chronic traction avulsion of proximal tibial tubercle at patellar tendon insertion).  The 1 May 2002 NARSUM, 4 months before separation, documented the CI started having trouble with symptoms of cold painful hands and purple fingertips with cold exposure in September 2000.  He complained of cold exposure intolerance because of the hand and finger symptoms.  The CI reported episodes of migratory arthralgias (joint pains) affecting his hips, knees, feet, shoulders, and hands.  “He was referred to the internal medicine clinic then referred to a civilian rheumatologist…  His ANA [antinuclear antibodies associated with autoimmune diseases] was strongly positive with a titer of 1:2560.  He developed concurrent symptoms of joint pains in his hands and feet and severe heartburn.  The consultant found no true arthritis or evidence of other connective tissue disease at the time. … He followed up with rheumatology in July 2001 and arthralgias without definite arthritis were again confirmed.  The recommendation was no cold exposure < 60 degrees due to Raynaud's.”  “A definite diagnosis of CREST [(calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) scleroderma syndrome], scleroderma, or other connective tissue disease has not been made.”  He complained of daily heartburn which was considered by his rheumatologist to be probably related to his syndrome.  The physical examination documented “a completely normal skin examination of the fingers and toes without scarring, ulceration, or trophic [soft tissue changes from nerve supply interruption] skin changes.  Examination of the joints was notable for mild tenderness to pressure over the first metacarpophalangeal joints of both hands without hypertrophy, warmth, or erythema [redness].  He was able to oppose the thumbs to the base of all the fingers.  Examination of the wrists, elbows, shoulders, knees, ankles, and lumbar spine were all unremarkable.  Examination of the feet was remarkable only for bilateral pes planus.”  The examiner recounted the findings of the X-rays and labs (strongly positive ANA and positivity of anti-RNP and anti-Smith antibodies).  The diagnosis listed Raynaud's syndrome, associated with arthralgias and esophageal reflux, but not currently causing scarring or ulceration.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 7117 code (Raynaud’s syndrome) citing onset of Raynaud's syndrome in September 2000, no inciting event, involving bilateral hands and fingers with pain and classical skin color changes on exposure to temperatures below 60 degrees, and no skin scarring, ulceration, or trophic changes by exam.  The VA assigned a 0% rating under the 7117 code (Raynaud’s syndrome) based on Service medical records and documented the CI failed to report (X3) as requested for scheduled VA C&P examinations.  The VA documented a non-compensable evaluation is assigned unless characteristic attacks occur one to three times a week.  Board members agreed that the disability more closely approximated the 10% (characteristic attacks occurring one to three times a week) than the 20% (characteristic attacks occurring four to six times a week) rating under 7117 (Raynaud’s syndrome).  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 syndrome.  

BOARD FINDINGS:  In the matter of the Raynaud’s syndrome condition and IAW VASRD §4.71a, 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 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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, AR20170002438 (PD201500663)

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