RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01031
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Test, Measurement and Diagnostic Equipment  Maintenance Support Specialist, medically separated for “chronic pain (x 3 years), right hip…” and “thrombophlebitis, right leg…” rated 0% and existed prior to service (EPTS), respectively, with a disability rating of 0%.

CI CONTENTION:  The CI requested a review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20061212	VARD – 20071004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain (x 3 Years), Right Hip…	5003	0%	Osteoarthritis of the Right Hip	5003-5252	10%	20070918	
Thrombophlebitis, Right Leg…	EPTS	Post Phlebitic Syndrome Due to Recurrent Deep Vein Thrombosis	7121	10%	20070918	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Hip.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the onset of the CI’s right hip pain began insidiously in 2003 without a known, specific traumatic event.  There was no surgical indication.  Radiographic imaging studies showed some decrease in the right hip joint space size.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 June 2006, 8 months prior to separation, the CI reported pain with running, extended standing, heavy lifting or moving into certain positions.  Pain was constant, but waxed and waned in severity.  Physical examination showed no right hip tenderness, but painful right hip motion and pain during squatting was present.  The CI could heel-toe walk without pain or a limp.  The MEB NARSUM examination on 10 August 2006, 6 months prior to separation, noted complaints of right hip pain with running, walking, mounting a bicycle or prolonged standing.  Pain was constant and prevented him from walking greater than 1 mile or standing for more than 15 minutes.  Physical examination showed right hip range of motion (ROM) limited by pain.  Flexion was 90 degrees (normal 125), abduction was 15 degrees (normal 45 degrees) and external rotation was 40 degrees (normal 45).  Measurements of extension and adduction were not provided.

At the 18 September 2007 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported constant right hip pain with occasional flare-ups and instability.  He was unable to stand for more than a few minutes or walk more than a few yards.  Physical examination showed a normal gait but with the right hip rotated outward due to the hip problem.  Painful right hip motion was present.  Measured flexion was 85 degrees, extension 20 degrees (normal 20), abduction 18 degrees, external rotation 40 degrees and adduction 20 degrees (normal 45).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5003 (arthritis, degenerative) citing range of motion limited by pain.  The VA rated the right hip condition 10% under a combination 5003-5252 code (degenerative arthritis; thigh, limitation of flexion), based on the VA C&P examination 7 months after separation, citing functional loss due to pain.  There was no limitation of extension, flexion, abduction, adduction or external rotation to warrant a rating higher than 0% under the respective limitation of motion codes (5251, 5252, and 5253).  Panel members agreed however that there was sufficient evidence of painful motion causing functional loss, thus a 10% rating (based on §4.59, §4.40 and §4.45) was supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip condition, coded 5003.  
 
Thrombophlebitis, Right Leg.  The requested thrombophlebitis condition is eligible for panel review to the extent that, although the panel does not have the authority to recommend a reversal of the service EPTS determination, it may review the fairness of the PEB’s judgment that there was not permanent service aggravation.  Should the majority of members agree that there was permanent service aggravation, a service disability rating IAW the Veteran’s Affairs Schedule for Rating Disabilities (VASRD), with or without a deduction IAW VASRD §4.22 (Rating of disabilities aggravated by active service), will be recommended.

According to the STR the CI’s right leg deep vein thrombosis (DVT) condition began in May 2006 (9 months prior to separation).  The CI took Coumadin (an oral blood-thinning medication) for 4 months, but 1 month after discontinuing that medication he developed another right leg DVT in November 2006.  Evaluation after the second DVT found the CI to have a Factor V Leiden gene mutation (an abnormal clotting factor that predisposes to blood clot formation).  The MEB forwarded “deep vein thrombosis of lower extremity” for PEB adjudication.

At a hematology follow-up evaluation on 27 November 2006 (2 weeks after initiation of treatment for the second DVT), the CI reported myalgias (muscle aches) in the right lower extremity and intermittent edema (swelling) of the thigh and calf.  Physical examination showed a mild increase in size of the right thigh and calf compared to the left.  The hematologist noted that the CI was heterozygous for Factor V Leiden (one copy of the gene was abnormal, not both copies) and concluded that a minimum of 1 year of anti-coagulation with Coumadin was required, but that life-long prophylaxis was a possibility.  The CI’s ongoing 15 year history of smoking as a risk factor for the development of DVT was addressed, and he was repeatedly advised to stop smoking.  Review of the STR found that, prior to the onset of the DVT condition, there was no history of trauma, prolonged immobilization, surgery or other significant disease (except the hip condition, above).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB determined the right leg DVT was a direct consequence of a genetic abnormality (which obviously existed prior to service) and that there was no permanent aggravation by the service beyond the normal progression.  The PEB therefore deemed the DVT condition, coded 7199-7120 (varicose veins), not eligible for disability rating and compensation.  The VA, however, stated “this disability is not shown to have existed prior to … military service.”  The VA rated the DVT condition 10% coded 7121 (post-phlebitic syndrome of any etiology), based on an examination 7 months after separation.  The panel’s main charge with respect to its recommendation is an assessment of the fairness of the PEB’s determination that there was no permanent service aggravation of this EPTS condition. A presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service.  All members agreed that the evidence supported the PEB’s position.  There was no evidence in the available record that other factors related to military service imposed additional risk of DVT development beyond that of the genetic abnormality.  Although the history of smoking may have elevated the risk, this factor was a personal lifestyle choice that was in place for several years prior to entry into the service.  There was no history of right lower extremity trauma (e.g. fracture requiring a cast), surgery, prolonged immobilization, malignancy, inflammatory bowel disease or kidney disease that could have contributed to thrombosis risk beyond that of the genetic mutation.  There was no objective evidence that the natural evolution of this condition was affected at all by military activities, or would not have occurred had he not joined the service.  After due deliberation, considering all of the evidence, the panel concluded the right leg thrombophlebitis condition was not permanently aggravated by service beyond the natural progression of the condition and therefore recommends no change in the PEB’s adjudication.

BOARD FINDINGS:  In the matter of the right hip condition, the panel unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the thrombophlebitis, right leg condition the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Hip Pain	5003	10%	
Thrombophlebitis, Right Leg	7199-7120	---%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007426, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure