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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03019.

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 re-characterization or modification 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 re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						

								

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX		CASE: PD-2017-03019 BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE: 20071024

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Security Force Specialist, medically separated for “recurrent deep venous thrombosis (DVT) of left thigh” with a disability rating of 20%.

CI CONTENTION: “The rating should at least be reviewed because the condition that rendered me unfit has worsened”  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 - 20070910	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent DVT Left Thigh	7199-7121	20%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Recurrent DVT of Left Thigh. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s initial episode of DVT manifested 19 March 2006. She was re- evaluated in November 2006 for repeat pain in her left thigh and was diagnosed with a second DVT this time in the left lower extremity (LLE). The 7 March 2007 MEB NARSUM examination, 7 months prior to separation, noted two episodes of DVTs. Medications included enoxaparin. Physical examination showed the CI’s general appearance to be healthy. Gait, balance and stance were  normal.   Lungs  were  clear to auscultation, bilaterally.   Full active range of motion    was

demonstrated. She denied pain to her left thigh and distally, was neuro-vascularly intact. The skin was without “cyanosis or lesions.”

During a 19 March 2007 family practice visit for pharyngitis she was instructed to follow up with hematology. She did not attend a hematology appointment until 5 June 2007 at which time she was evaluated for symptoms that started after getting a new tattoo. At that visit she stated she was still on Lovenox and needed a refill which was provided with the understanding that she would follow up with hematology. During the 13 June 2007 MEB NARSUM addendum, 4 months prior to separation, the examiner noted that the CI had two episodes of DVT and “medical care non-compliance.” The examiner stated, in January the CI was referred to hematology and was taking the medication Lovenox daily as directed but she had not returned to see hematology since June 5, 2007. A medication search was conducted and “it showed no on or off base refills for Lovenox.  The examiner concluded the CI had not followed medical recommendations.

After the 20 July 2007 hematology consultation examination, 3 months prior to separation, the physician noted that subsequent to the pregnancy in 2005, she was placed on a birth control patch, which she used fairly regularly, but she developed a DVT. She was started on anticoagulation. Warfarin (anti-coagulant) was discontinued in the fall of 2006 with noted difficulty and she developed a DVT again in the LLE. An extensive work-up was performed in January 2007, which was negative. She became pregnant again and experienced a miscarriage. At that time the CI started to have more difficulty with her LLE. Review of systems noted she had “been feeling relatively well.” The examiner noted no history of arthralgia, arthritis or skin rash, and added, “she has evidently not been documented to have any pulmonary emboli.” Physical examination showed the CI did not appear to be acutely ill. Her color was “good.” Skin was clear without rash and there was no lymphadenopathy. Chest was clear and heart was normal. There was left calf swelling but no measurements were given. There was no increased venous pattern or plethoric changes of the left leg. Joints and pedal pulses were within normal limits. The physician examiner noted the recent pregnancy and miscarriage were aggravating factors. “Otherwise I think she should remain on Warfarin indefinitely and hopefully with a lot of help in education she will take the medication as directed and her pro times can be controlled.”

The 25 July 2007 hematology consultation follow-up examination, 3 months prior to separation, noted complaints that the leg was swollen, but the pain has subsided. She tolerated the anticoagulation well. The examiner reported the CI was not coughing or short of breath. Her chest was clear and the heart examination was unremarkable. Her LLE was larger than the right, “but not acutely tender or discolored.” She was given a referral for compression devices and or stockings.

The 30 August 2007 hematology consultation follow-up examination, 2 months prior to separation, the CI had no evidence of recurrence of phlebitis. There was no increase in pain or swelling of the LLE. She was not wearing a support stocking and has been active and functional. Otherwise, there was no cough, chest pain or shortness of breath nor any other complaints. She reported she has resumed normal menstruation and is not on birth control. Physical examination showed the left calf is roughly one inch larger in circumference than the right. Chest, heart, and abdominal examinations were otherwise unremarkable. The plan was to continue the Warfarin indefinitely.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the thrombosis condition 20%, analogously coded 7199-7121 (post-phlebitic syndrome). The panel agreed there was no evidence of stasis pigmentation or eczema with persistent edema, thus the next higher 40% rating was not justified on this basis. There was also, no evidence supporting a compensable rating under code 6817 (pulmonary vascular disease - chronic pulmonary thromboembolism) as there was no evidence of lung or cardiac dysfunction. There is no VASRD §4.104 rating higher than the 20% adjudicated by the PEB under any applicable

code. 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 thrombotic condition.

BOARD FINDINGS: In the matter of the recurrent deep venous thrombosis of the left thigh 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: