RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01057
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060625

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

CI CONTENTION:  “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 progression or complications of service-connected conditions after separation.  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 - 20060515	VA - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud Phenomenon	7117	10%	No VA Examination in Evidence	
Arthralgias probably related to Raynaud’s Phenomenon	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Raynaud Phenomenon (Subsuming Category II Arthralgias).  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a 2-year history of multiple spine and joint complaints (arthralgias) that included the back, neck, ankles, knees, elbows, and finger joints.  There were multiple primary care and orthopedic entries in the STR that addressed all of these.  Multiple imaging studies of the entire spine and all involved joints were negative except for the possibility of meniscal disease in the left knee (but not present on arthroscopy).  Serologic markers for rheumatologic disease (rheumatoid factor, citrulline antibody) were elevated and the CI was referred to rheumatology.  The rheumatologist elicited a history of Raynaud’s phenomenon (vasospasm blocking circulation with accompanying pain and discoloration of the digits, often triggered by cold or emotional stress) in addition to the arthralgias; excluded fibromyalgia (no requisite tender points) and common rheumatologic diseases; and, documented a diagnosis of “Raynaud's phenomenon with associated arthralgias.”  Neither the rheumatologist nor any STR clinical entry documented a specific frequency of Raynaud’s attacks, and there was no documentation of any digital ulcers or other complications.  There were multiple STR entries that documented normal range of motion of all spinal segments and involved joints.

The 13 January 2006 NARSUM examination (5 months before separation) documented ongoing complaints of “recurrent arthralgias and swelling of both hands, knees, and ankles ... worse in the morning” that were exacerbated by “any kind of prolonged sitting or standing.”  The physical examination was normal except for some mild swelling of the finger joints.  There were no findings suggestive of circulatory or nerve impairment.  The remainder of the examination, musculoskeletal and otherwise, was normal.

There was no VA claim, examination, or clinical notes on file; and, there was no other evidence after separation in this case.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 7117 (Raynaud’s syndrome) did not cite a rationale.  The PEB adjudicated the associated arthralgias as Category II (conditions that contribute to the unfitting condition).  Although the arthralgias were a prominent feature of this case, code 7117 is very specific to the unfitting Raynaud’s diagnosis; and, members agreed that the analogous application of any alternate code was not sufficiently justified by VASRD §4.20 (analogous ratings).  Furthermore, there is no applicable code for the arthralgias other than rating the disability analogously to fibromyalgia (code 5025), a diagnosis that was specifically excluded by the rheumatologist.  Although not specified in the VASRD, a rheumatologist-confirmed diagnosis of fibromyalgia is required by the VA for rating under 5025; and, that notwithstanding, a requirement for “tender points” (excluded by the rheumatologist) is stipulated by the rating language of code 5025.  

The panel agreed that rating under criteria of code 7117 (subsuming the Category II arthralgias) was appropriate, members turned to deliberation of the fairness of the PEB’s 10% rating under those criteria.  The 10% criterion of 7117 is “characteristic attacks occurring one to three times a week;”  the 20% criterion is “occurring four to six times a week;” and, the 40% criterion is “occurring at least daily.”  The higher ratings require digital ulcers and complications not in evidence.  A specific frequency of Raynaud’s attacks was not evidenced in the STR, and there was no VA evidence which may have been more directed toward ratable frequency.  None of the service documentation (STR clinical notes, rheumatology consult, or NARSUM) suggested that the Raynaud attacks were a common and frequent occurrence; and, members agreed that to propose a higher frequency than that reflected in the 10% criteria would require undue speculation, even considering the mandate of reasonable doubt.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the Raynaud Phenomenon condition.

BOARD FINDINGS:  In the matter of the Raynaud Phenomenon (subsuming the Category II arthralgias condition) and IAW VASRD §4.104, 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, therefore, recommends that there be no modification and no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS

Subj: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability
rating previously assigned by the Department of the Navy 's Physical Evaluation Board :

-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX ., XXX XX XXXX, former USN
-	XXXXXXXXXXXXXXXXXX, XXX XX XXXXX, former USMC
-	
XXXXXXXXXXXXXXXXXX, XXX XX XXXX, former USN