RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02796
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Weather Forecaster Journeyman, medically separated for “thromboembolic disease” with a disability rating of 20%.  

CI CONTENTION:  “I continued to have DVT and this caused permanent damage to my entire left leg.  I’ve had surgery twice to help with the continued pain and damage but still struggle with the limitations.”  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 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 – 20050204	VARD – 20050623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thromboembolic Disease…	7121	20%	Proteins Deficiency w/ Hypercoagulable State Multiple DVT LLE, Post Phlebitic Syndrome Left Leg 	7121	20%	20050608	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Thromboembolic Disease…  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s thromboembolic disease began in March 2004 after a spontaneous vaginal delivery of a term infant.  Post-delivery, she developed a 20 cm hematoma in her left vaginal wall which had to be incised and drained.  Subsequently, she developed a deep venous thrombosis (DVT) in her left common femoral vein extending to the distal inferior femoral vein just proximal to the popliteal vein.  Treatment with anti-coagulants was begun with plans to discontinue in 6 months.  During this time hematology-oncology rendered a diagnosis of Protein S deficiency.  After a trial on aspirin alone she developed marked swelling in her left lower extremity (LLE).  On September 2004 the CI presented to the emergency room complaining of shortness of breath and chest pain.  The ultrasound was positive for a new LLE DVT.  She was hospitalized for 4 days for intravenous anti-coagulation.  Since the initial DVT, the CI had missed about 100 days of work. 

The 27 September 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of LLE swelling and chronic daily pain somewhat controlled with as-needed narcotics.  Treatment requirements included long term anti-coagulation, no prolonged standing and sitting, use of compression stockings except at bedtime, and elevation of the lower extremities at least three times per day for 30 minutes.  Physical examination showed 1+ pitting edema in her LLE despite the use of compression stockings.  

At the 8 June 2005 VA Compensation and Pension (C&P) general examination, 3 months after separation, the CI reported persisting swelling of the left leg, controlled somewhat by compression stockings, but worsened with dependency (on her feet for an hour).  There was a minor dull pain in her leg diffusely, which worsened to a moderate discomfort when the leg was swollen.  She had to elevate her leg at least hourly to avoid increased pain and swelling.  The pain did not require strong pain medications and she took an oral anti-coagulant.  The CI was at home with her 1-year old baby and was not seeking employment.  She was told she was unable to stand or sit for long periods and must elevate the left leg at intervals.  Physical examination showed normal gait and posture.  The CI wore thigh- high compression stockings on the left leg.  The left leg showed increased diameter throughout compared to the right, with chronic mild edema, not board-like and with no palpable cords or thrombosed vessels.  The December 2006 VA C&P “arteries, veins and miscellaneous” examination concluded the CI was in remission from DVT with residuals of post-phlebitis syndrome with pain in the LLE.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the thromboembolic disease 20%, analogously coded 7121 (post-phlebitic syndrome of any etiology (DVT)).  The PEB cited the DoD and VA Schedule for Rating Disabilities guidelines.  The VA based the rating on the C&P examination, citing persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. Panel members noted that both the NARSUM and C&P examinations recorded persistent edema, incompletely relieved by elevation of the extremity.  There was no evidence of stasis pigmentation or eczema with or without intermittent ulceration to warrant a 40% disability rating.  The panel concluded the CI’s condition met the criteria for 20% disability.  After due deliberation, considering all 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 thromboembolic disease.  

BOARD FINDINGS:  In the matter of the thromboembolic disease and IAW VASRD §4.71a, 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 20170419, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02796.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.