RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02109
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20090930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Electrical Mechanical Equipment Repairman, medically separated for “DVT [deep vein thrombosis] with recurrent PE [pulmonary embolism]” with a disability rating of 20%.  

CI CONTENTION:  He will be on anti-coagulation medication for the rest of his life.  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 - 20090410	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DVT with Recurrent PE	7121	20%	No VA Examination in Evidence	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

DVT with Recurrent PE.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially presented with a DVT in his right lower extremity in 2005.  He subsequently completed 6 months of Coumadin anticoagulation therapy.  In February 2008, the CI presented to an emergency room with shortness of breath, and was found to have bilateral pulmonary emboli on the right and left main pulmonary arteries as well as on branch arteries.  

During the 26 January 2009 MEB NARSUM examination, 8 months prior to separation, the CI reported feeling well without current complaints.  He was receiving a therapeutic dose of an anti-coagulation medication.  Physical examination showed his lungs were clear to auscultation bilaterally.  There were no wheezes, rhonchi or rales.  His cardiovascular examination showed a regular rate and rhythm, and normal S1/S2 (first and second heart sounds).  There were no murmurs, rubs or gallops.  Examination of the lower extremities revealed a compression stocking on the right side with positive edema.  There was no edema on the left and the CI had good distal pulses bilaterally.  The examiner noted the CI had two unprovoked blood clots and required lifelong Coumadin therapy.  

At the 2 July 2009 internal medicine examination, 2 months prior to separation, the CI reported intermittent pain and swelling in the right lower leg.  Examination showed a large area of hyperpigmentation medial to the right pretibial region.  The right extremity was mildly edematous with numerous small dilated veins.  There was pitting edema on the right with localized pitting edema of the right ankle.  The examiner noted the hyperpigmentation of the skin indicated chronic venous stasis in the leg that had a DVT.  There was no VA Compensation and Pension evaluation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DVT condition 20%, coded 7121 (post-phlebitis syndrome of any etiology).  The NARSUM examination noted the CI wore a compression stocking and had swelling of the right lower extremity.  The internal medicine examination noted the presence of a large area of hyperpigmentation on the lower right leg with swelling.  Panel members agreed the VASRD §4.104 threshold for a 40% rating was reasonably satisfied in this case on the basis of persistent edema and stasis pigmentation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 40% for the DVT condition, coded 7121.  

BOARD FINDINGS:  In the matter of the DVT condition, the panel majority recommends a disability rating of 40%, coded 7121 IAW VASRD §4.104.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Deep Vein Thrombosis with Recurrent Pulmonary Embolism	7121	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, undated, with attachments
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		     COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	 (b) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (g) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX    
	 (h) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (i) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.
    
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                              	XXXXXXXXXXXXXXXXXX
                              	Acting