RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02515
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “Raynaud’s disease” with a disability rating of 0%.  

CI CONTENTION:  The CI contended for the Raynaud’s disease and both knees, stating “her file was not reviewed or assessed properly.”  Her other conditions are not in PDBR scope.  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 - 20030711	VARD - 20070822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud’s Disease…	7117	0%	Raynaud’s Disease	7117	0%	20070717	
Patellofemoral Disease	Not Unfitting	Right Knee Sprain	5260	10%		
		Left Knee Condition	5259-5257	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC%	

ANALYSIS SUMMARY:  

Raynaud’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Raynaud’s disease condition began 7 years prior to the NARSUM, during basic training, after a cold injury during a road march.  The CI continued to have symptoms of Raynaud’s disease.  

The 22 May 2003 commander’s statement indicated that the CI was unable to perform all outside duties required of her (while stationed in Germany), and that due to temperature changes and the handling of metal and fuel, “it impacts her performance with her hands drastically.”  

The 18 June 2003 MEB NARSUM examination, 4 months prior to separation, was performed by a rheumatologist and noted complaints of Raynaud’s disease.  She related that the tips of her fingers would turn white and purple with slight temperature changes, occurring at least 25-30 times a year.  She had noted some fingertip swelling and indicated that she had no history of skin ulcers and no other areas were involved.  Physical examination showed no significant skin lesions, with normal skin texture.  Hands were cool to touch bilaterally, and all joints had full range of motion.  

At the 17 July 2007 VA Compensation and Pension (C&P) evaluation, performed 44 months after separation, the CI reported "whenever the weather changed she had tingling and pain with her finger's turning white and then purple.  She indicated she gets more symptomatic with temperatures of 65 degrees or less.  Physical exam was noncontributory.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Raynaud’s disease condition 0%, coded 7117 (Raynaud’s syndrome), citing the CI did not meet the minimal rating criteria.  The VA also rated the Raynaud’s disease condition 0% coded 7117, based on the C&P examination 44 months after separation, citing average temperatures in Tampa FL indicated that the condition was intermittent, and assignment of a noncompensable evaluation unless characteristic attacks occur one to three times per week.  

The panel adjudged that the NARSUM and STR evidence had the highest probative value due to the remoteness of the C&P examination.  There was no evidence of auto-amputation or cutaneous ulcers, and therefore the rating criteria are based on the frequency of characteristic attacks.  The next higher 10% rating is for “characteristic attacks occurring one to three times a week.”  The panel deliberated if the CI’s history of episodes occurring “at least 25-30 times a year” was closer to the 10% rating criteria or the 0% rating IAW VASRD §4.31 (a no-percent rating).  The panel also considered the average temperatures in Germany were below 65 degrees for a preponderance of the year with daily low temperatures below 60 degrees throughout the year.  

The panel consensus was that the frequency of the CI’s episodes more nearly approximated the level of disability envisioned by the 10% criteria, and that a 10% rating under code 7117 was warranted IAW VASRD §4.7 (higher of two evaluations).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the Raynaud’s disease condition, coded 7117.  

Contended PEB Conditions:  Patellofemoral Disease (Knee).  The panel’s main charge is to assess the fairness of the PEB’s implied determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend an unfit determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the Raynaud’s disease condition, the panel majority recommends a disability rating of 10%, coded 7117 IAW VASRD §4.104.  In the matter of the contended patellofemoral disease condition, the panel agrees that it cannot recommend it for additional disability rating.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  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	
Raynaud’s Disease	7117	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013276, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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