RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00921
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Chemical Operations Specialist, medically separated for “connective tissue disease, manifested by Raynaud’s phenomenon” with a disability rating of 10%. 

CI CONTENTION:  “Raynauds disease, low back injury L5-S1, Tietze’s syndrome, bilateral plantar fasciitis, depression.”  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 - 20070703	VARD - 20071207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Connective Tissue Disease, Manifested by Raynaud’s Phenomenon	6399-6350	10%	Raynaud’s Phenomenon with Evolving Connective Tissue Disorder	7117	10%	20070824	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Connective Tissue Disease, Manifested by Raynaud’s Phenomenon.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s connective tissue disease began in October 2006 when he developed significant pain in his right foot which progressed with peripheral color changes of the skin and altered distal sensation in cool/cold weather.  The CI reported he had long been suspected of having Raynaud’s phenomenon.

At the 17 January 2007 MEB NARSUM examination, 9 months prior to separation, the CI’s chief complaint was “cold hands and feet.”  His physical examination revealed blotchy skin colors of purple and white on both hands and feet with evidence of decreased capillary refill.  There was no evidence of skin ulcerations, lesions, nodules, or diminished sensation.  Peripheral X-rays did not reveal any fractures and blood tests indicating a disorder of connective tissue were positive.  His diagnosis was that of an “evolving connective tissue disease, manifested by Raynaud’s phenomenon.” At the 24 August 2007 VA Compensation and Pension (C&P) examination, one month prior to separation, the CI described his hands often became red and pruritic (itch) and then turn blue and numb.  Additionally, his feet became numb as well.  He endorsed the inability to use his hands or maintain a gait during an attack.  Attacks occurred “…as often as 4 times per day.”  There was no comment on the duration of each attack.  Under the heading of diagnosis, the VA provider documented, “The objective factors (with regards to Raynaud’s phenomenon) are none at present as it is currently summer with warm conditions.”    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the connective tissue disease 10%, analogously coded as 6350 (lupus erythematosus, systemic (disseminated)).  The VA rated the condition as “Raynaud’s phenomenon with evolving connective tissue disorder,” 10%, coded 7117 (Raynaud’s syndrome), based on the C&P examination, citing characteristic attacks occurring one to three times a week.

Panel members first considered the appropriate VASRD code in this case and although code 7117 is specific for Raynaud’s syndrome, this case consistently noted the primary and underlying condition was that of a connective tissue disorder whereby its presenting symptomatology was manifested by that of the phenomenon of Raynaud’s.  Therefore, panel members agreed that the more appropriate VASRD code in this case was appropriately captured under 6350 (systemic lupus erythematosus).  The rating levels under 6350 are 10%, 60% or 100%.  The 60% level requires symptom exacerbations lasting a week or more, 2 or 3 times per year.  Although no time duration of symptom exacerbation was documented in the records, evidence of having multiple attacks during a single day would not meet the 60% (lasting a week or more) criteria.  Having symptoms during the year did support the 10% impairment rating.  Therefore, 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 connective tissue disease.   

BOARD FINDINGS:  In the matter of the connective tissue disease condition and IAW VASRD §4.88b, 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.  

AR20180014699  XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

         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.