RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02307
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aerospace Physiology Craftsman, medically separated for “idiopathic Raynaud’s phenomenon” with a disability rating of 10%.

CI CONTENTION:  Raynaud’s phenomenon warrants a medical retirement.  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 - 20080310	VARD - 20141014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Raynaud’s Phenomenon	7117	10%	Raynaud’s Syndrome	7117	20%	20141014	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Raynaud’s Phenomenon.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s idiopathic Raynaud’s phenomenon was first treated in April 2007 after numbness and tingling in her fingers and toes for 2-3 prior years.  She reported the symptoms were spontaneous, starting with a pale color and changing to a blue-purple color with associated tingling followed by numbness and with minimal pain.  The episodes lasted 15-30 minutes and resolved spontaneously.  She experienced symptoms 4-5 times per week, without associated symptoms.  A diagnosis of idiopathic Raynaud’s was rendered and she was placed on two non-steroidal medications.  Episodes decreased.

The 5 December 2007 MEB NARSUM examination, 7 months before separation, noted complaints of Raynaud’s symptoms that had increased as the temperature grew colder.  After 2 months of treatment symptoms increased to 4-5 times per month.  Her symptoms were exacerbated by her hypobaric chamber duties for a 6 month period.  She was placed on non-mobility status since colder areas exacerbated her symptoms.  Physical examination showed her fingers felt cold, clammy to touch, and their color was pale without rashes or redness.  Strength, sensation and neurological were intact.  The examiner recommended she continue her Raynaud’s medications.

A 31 March 2008 MEB Re-evaluation, 3 months prior to separation, noted the CI had frequent episodes for 10 days when she rang out of medicine while traveling.  Medication was started 6 days previously and symptoms were occurring much less frequently.  She had not observed any areas that were permanently pale or cyanotic.  There was minimal pain or discomfort.  She occasionally felt cold and paleness of the skin in the fingers of both hands 1-3 times per day, especially if cold.  The examiner noted transient rebound symptoms resolved after restarting medication.  Since she still had episodes, daily medication was increased.

The separation physical, dated 22 May 2008, 1 month before separation, the CI reported occasional Raynaud’s attacks about 2 times per week lasting 20 minutes, primarily exacerbated by cold.

There was no VA examination proximate to separation for the panel to review.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Raynaud’s condition 10 %, coded 7117 (Raynaud’s).  The VA rated the Raynaud’s condition 20% coded 7117, based on the C&P examination 6 years after separation, citing characteristic attacks 4-6 times per week.  

The code 7117 criterion for a 40% rating requires “daily” characteristic symptoms, while a 20% rating requires “four to six times a week.”  The panel noted the preponderance of evidenced noted in the last three examinations (4-5 times per month; 1-3 times per day; and 2 times per week), most proximate to separation, did not support characteristic attacks for either rating.  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 idiopathic Raynaud’s phenomenon condition.

BOARD FINDINGS:  
In the matter of the idiopathic Raynaud’s phenomenon condition and IAW VASRD §4.104, the Board 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 20150827, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02307.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings