RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01343
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “post-phlebitic syndrome” with a disability rating of 0%.

CI CONTENTION:  Current clotting condition supports a higher rating.  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 - 20080918	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Phlebitic Syndrome (DVT)	7121	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Deep Venous Thrombosis (DVT).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s DVT condition began in February 2005 without specific injury or trauma.

The 13 July 2008 MEB NARSUM examination, 3 months before separation, noted complaints of recurrent DVT and left leg pain.  The CI reported a history of left leg DVT in February 2005 prior to military entrance and her coumadin (blood thinner/anti-clotting agent) was stopped in December 2006.  In June 2008 the CI developed left thigh edema with ultrasound diagnosis of a left lower extremity popliteal and superficial femoral DVT, and she was started on anticoagulation therapy.  Emergency department visits indicated the CI had left leg pain with walking.  Hematology/Oncology evaluation noted elevated Factor VIII (possible blood clotting) and recommended indefinite anticoagulation.  The CI was taking daily coumadin.  Physical examination showed extremities with no clubbing, cyanosis or edema.  The left calf and popliteal area were soft and tender.  There were no palpable cords (hard veins) and Homan’s sign (check for DVTs) was negative.  The physician indicated that the CI’s “DVT and calf pain requires significant activity Profile limitations,” with a plan for at least one year of anti-coagulation therapy.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DVT condition 0%, coded 7121 (post-phlebitic syndrome of any etiology), citing recurrence of DVT.  There was no evidence of edema, eczema, stasis pigmentation, ulcers, or other skin changes in the left lower extremity.  The CI’s symptoms included leg tenderness with calf pain requiring activity limitation.  The panel deliberated if there was sufficient evidence of “aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery” to warrant the next higher 10% rating.  The panel adjudged that symptomatic leg pain with activity relieved by rest/activity restriction, most nearly represented the disability picture of the 10% criteria.  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 post-phlebitic syndrome (DVT) condition, coded 7121.

BOARD FINDINGS:  In the matter of the post-phlebitic syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 7121 IAW VASRD §4.104.  There were no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification of disability rating previously assigned, without re-characterization of the CI’s separation.

CONDITION	VASRD CODE	PERMANENT RATING	
Post-Phlebitic Syndrome	7121	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record

AR20170007636, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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