RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00852
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Information Systems Technician, medically separated for “deep venous thrombosis to the left lower extremity” with a disability rating of 20%.  “Coagulopathy due to a genetic defect specifically anticardiolipin antibody” was determined to have existed prior to service (EPTS) and was not rated.  

CI CONTENTION:  The CI submitted a 2-page letter providing background, questioning why he was released from active duty, and contending his rating should be changed to a retirement due to his length of service, the permanent damage caused by his condition, and the risk of being on Coumadin.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031218	VARD - 20040831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Deep Venous Thrombosis …	7121	20%	Deep Vein Thrombosis, Lt Lower Extremity	7121	10%	20031022	
Coagulopathy …	EPTS					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Deep Venous Thrombosis (DVT) to the Left Lower Extremity (LLE).  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s DVT condition began in March 2003 after experiencing a 9-hour car trip followed by a 16-hour airplane flight while deploying to Bahrain.  An ultrasound duplex of his LLE revealed a DVT.  The CI was followed by the coumadin clinic for maintenance of therapeutic dosing of the coumadin.

At the 2 June 2003 MEB NARSUM examination, 11 months prior to separation, the CI reported that both his parents had a history of DVT.  Physical examination was unremarkable with the exception of prominent swelling of the LLE.  The skin of the LLE was intact without bruising.  Pulses were equal bilaterally.  There was some evidence of positive Homan sign (possible blood clot present).  Laboratory studies one month before the NARSUM showed evidence of a coagulopathy secondary to a genetic defect (factor V Leiden).  During the 24 June 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI noted he was concerned about the swelling and burning in his leg.  Physical examination was unremarkable.  The 9 September 2003 internal medicine clinic encounter documented a ¾-inch difference in the size of the right calf versus the left, with the left being larger.  The physician noted there had been no history of bleeding or bruising.  The CI reported he had engaged in light jogging.

At the 22 October 2003 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported left leg and calf pain.  He stated that his condition prevented him from participating in any activity that might risk him falling.  The CI complained of nighttime leg cramps, which made sleeping difficult.  He was unable to stand or sit too long, and he had occasional burning sensation in his left leg. Examination of the lower extremities showed the right calf slightly smaller than the left (4cm difference), and the left leg with mild non-pitting edema.  Motor and sensory function of lower extremities were both normal.  The skin examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The CI underwent a formal PEB which rated the DVT condition 20%, coded 7121 (post-phlebitic syndrome of any etiology), citing persistent swelling of the lower extremity that is incompletely relieved with elevation with no evidence of stasis pigmentation. On 5 January 2004, the PEB wrote, “The recent physical examination documents the persistence of signs with persistent swelling of the lower extremity with a difference of approximately 2 inches at the level of the calf.  The Board members observed the member’s extremities during the hearing and the left was grossly larger than the right.  The member’s condition [had] not resolved with treatment.  The member [was] unable to stand or walk for prolonged periods or perform any vigorous physical activity.  The continued manifestation of symptoms and need for frequent rest and elevation of his extremity precludes the adequate performance of military duties.”  The PEB adjudicated the condition of coagulopathy due to a genetic defect as EPTS, and opined that the secondary condition (DVT) was a residual considered service aggravated.  No deduction was taken for the EPTS condition.  The panel found no evidence to indicate this was incorrect given the medical evidence of a genetic defect (factor V laden, anticardiolipin antibody) known to produce a hypercoagulable state, thus, an increased risk of blood clots.

The VA rated the DVT condition 10%, also coded 7121, based on the C&P examination, citing evidence of 1+, non-pitting swelling of the LLE, a left calf measurement 4 cm greater than in the right lower extremity, peripheral pulses that were equal in both lower extremities (2+ for the femoral and popliteal pulses and 1+ for the dorsalis pedis and anterior tibialis pulses) and no evidence of neurologic dysfunction, stasis pigmentation, or eczema.  The higher rating of 40% requires persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration.  Panel members agreed there was no justification for the higher rating.  There were no other applicable codes for panel’s consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the DVT condition.  

BOARD FINDINGS:  In the matter of the DVT condition and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC