RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00125
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “chronic lymphedema right leg” with a disability rating of 20%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his daily activities.  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 - 20050307	VARD - 20060712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lymphedema, Right Leg	7121	20%	Residuals of Right Talus Hairline Fracture with…Lymphatic Damage	7199-7121	40%	20060314	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Lymphedema, Right Leg.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fractured a bone in his right foot in 2003.  He then presented with pain and swelling of his right lower leg in June 2004.  He was initially treated for cellulitis (an infection of the soft tissue) of the right lower extremity (RLE).  While hospitalized, he was also treated for eczema of the right foot.  The records show that he had a history of eczema prior to service.  The CI improved with antibiotics and was discharged after 4 days.  The next day a lymphangiogram showed lymphatic obstruction of the RLE.  He was evaluated in vascular surgery on 3 August 2004.  Pitting edema (fluid in the soft tissues) was noted, but skin changes were absent.  He was issued compression stockings and advised to periodically elevate his leg above the level of the heart.  He was unable to wear military foot wear due to the swelling and referred for an MEB.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 December 2004, 6 months prior to separation, the CI reported a history of eczema as a teenager and continued swelling of the RLE.  On examination, he was noted to have RLE edema, but was not recorded as having eczema or discoloration of the RLE.  He did have eczema of the upper back and dry skin of the face.  The MEB NARSUM examination was performed on 18 January 2005, 5 months prior to separation.  On examination, he was noted to have edema and to walk with a limp.  Neither eczema nor signs of venous stasis was documented.  The CI was seen on 5 May 2005, 1 month prior to separation, for a gastrointestinal complaint and noted to be free of a rash.  At the VA Compensation and Pension (C&P) evaluation performed on 14 March 2006, 9 months after separation, the CI reported that he fractured his ankle in 2003.  He reported ongoing swelling of the RLE for which he used a compressive stocking.  He also endorsed dry skin over the RLE.  On examination, edema of the RLE was present.  The gait was normal.  Neither eczema nor signs of venous stasis was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic lymphedema right leg condition 20%, coded 7121 (post-phlebitic syndrome of any etiology), citing swelling that did not resolve and marked ambulatory dysfunction.  The VA rated the right leg condition 40% analogously coded 7199-7121, based on the VA C&P examination 9 months after separation, citing persistent edema and eczema without persistent ulceration.  The panel considered the evidence.  The CI was treated for eczema of the RLE while hospitalized for a RLE cellulitis.  There was no other record showing treatment for eczema of the RLE in evidence.  The CI also stated that he had dry skin of the RLE.  The panel observed that he had also had been noted to have dry skin of the face on the DD Form 2808 and that dry skin is not eczema.  The criteria for a 40% rating included stasis pigmentation or eczema.  There is no evidence that either was present at separation.  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 for the chronic RLE condition.  

BOARD FINDINGS:  In the matter of the chronic right leg lymphedema 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160317, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014058, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure