RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00762
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated from the Temporary Disability Retired List (TDRL) for “Raynaud’s phenomenon” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20051006	VARD - 20051220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Raynaud’s Phenomenon	7199-7117	0%	Raynaud’s Phenomenon	7117	20%	20050613	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Raynaud’s Phenomenon.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s Raynaud’s phenomenon condition began in September 2002 when he developed cold-induced three-color finger changes.  He was subsequently diagnosed as having primary Raynaud’s phenomenon and treated with calcium channel blockers and topical ointments.  However, he could not tolerate temperatures below 60 degrees Fahrenheit and could not perform his duties as a military police officer.  After separation, the CI moved to a warm climate in the southwest and engaged in rigorous cold-avoidance measures.  He did not use air conditioning in his car and wore gloves if he were in an air-conditioned room.  With those techniques the frequency of attacks decreased from three times per week to three times per month, typically resolving in 30-60 minutes, although the most severe, provoked by swimming in water, lasted for 2 hours.  

At the 13 June 2005 VA Compensation and Pension (C&P) examination, 4 months before TDRL removal, the CI reported Raynaud’s phenomenon on no medication.  Upon exposure to temperatures below 60 degrees the tips of his second, third, and fourth fingers on each hand became white and numb and subsequently turned blue with throbbing pain of 10/10.  Upon warming they throbbed, swelled, and turned red.  Attacks lasted approximately 1½ hours, about once per month.  He had very minimal involvement of his toes.  As long as he avoided cold exposure, he was fine.  Physical examination showed no ulcerations or auto-amputations.  His hands were sweaty, but normal in color.  No changes of the nails were noted and no temperature changes were evident.  His grip was normal.  Laboratory studies were reported to be normal.  

The 25 September 2005 TDRL evaluation, 1 month prior to TDRL removal, noted Raynaud’s phenomenon with attacks three times a month.  Physical examination showed his blood pressure was 120/58, heart rate 47 beats/minute, respiratory rate 16 breaths/minute, and temperature 97.6 degrees Fahrenheit.  He was well-developed, well-nourished, in no acute distress, and was alert and oriented times three.  He had 2+ radial artery pulses and capillary refill was less than 1 second.  Nail fold capillaroscopy was normal.  There was no sclerodactyly (localized thickening and tightness of the skin of the fingers or toes), calcinosis cutis (calcium deposits in the skin), or telangiectasia (tiny blood vessels).  The digital pulp was normal with no digital ulcerations.  Additionally, there was no malar erythema (redness of the cheeks) or palpable purpura (visible non-blanching hemorrhage).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Raynaud’s phenomenon condition 0%, analogously coded 7199-7117 (Raynaud’s syndrome), citing the condition was of such a mild degree that it did not meet the criteria for even the lowest rating provided in the VASRD.  The VA rated the Raynaud’s phenomenon condition 20% (a continuation of a prior rating), coded 7117, based on the C&P examination, citing characteristic attacks occur four to six times a week.  

Panel members noted that the CI reported characteristic attacks three times a month with a highly compliant series of procedures including having moved to a warm climate to avoid the cold.  With attacks three times a month, the majority of weeks per month the CI would have an attack at least once a week.  Therefore, a 10% rating is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the Raynaud’s phenomenon condition, coded 7199-7117.  

BOARD FINDINGS:  In the matter of the Raynaud’s phenomenon condition, the panel recommends a disability rating of 10%, coded 7199-7117 IAW VASRD §4.104.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Raynaud’s Phenomenon	7199-7117	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007229, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure