RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03074
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aerospace Ground Equipment Craftsman, medically separated for “chronic deep venous thrombosis associated with Factor 5 Leyden Mutation” with a disability rating of 10%.  

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 – 20050912	VARD - 20051117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Deep Vein Thrombosis (DVT)    Right Lower Extremity	7199-7121	10%	Chronic DVT Right Lower Leg	7199-7121	20%	20051110	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic DVT Associated with Factor V Leiden Mutation, Right Lower Extremity.  According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered acute pain in his right lower leg in August 2003.  He was subsequently diagnosed with DVT and factor V Leiden mutation.  A 14 April 2005 vein study showed occlusions of the superficial femoral, popliteal, and posterior tibial veins.  

The 26 July 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain and swelling of his right lower leg with vigorous activity.  He also reported occasional cramps at night.  Physical examination showed leg diameter measurements 6 inches above the knees of 54 cm on the right and 51.5 cm on the left.  The diameter of his calves were 46 cm on the right and 41 cm of the left.  There was no tenderness of the lower legs.  

At the 10 November 2005 VA Compensation and Pension (C&P) examination, 7 days after separation, the CI reported he could walk 5 blocks before needing to rest.  Physical examination showed a normal gait.  The right calf was much larger than left.  The right lower extremity was moderately swollen and there was mild distal lower extremity edema.  The right mid-calf was 46 cm around and the unaffected left calf was 41 cm.  There was a small varicosity noted below the right knee.  The examiner noted the chronic DVT of the right lower leg would require life-long anticoagulation therapy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DVT 10%, analogously coded 7199-7121 (post-phlebitic syndrome).  The VA rated the DVT 20%, also coded 7199-7121, based on the C&P examination, citing persistent swelling in the right lower extremity along with complaints of muscle fatigue.  The panel agreed that a 20% rating, but no higher, was justified for persistent edema, incompletely relieved by elevation of the right lower extremity, as reported on the VA examination.  There was no evidence of stasis pigmentation or eczema with persistent edema, thus the next higher 40% rating was not justified on this basis.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the DVT, analogously coded 7199-7121.  

BOARD FINDINGS:  In the matter of the DVT, the panel recommends a disability rating of 20%, analogously coded 7199-7121 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	
Chronic Deep Venous Thrombosis	7199-7121	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170320, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03074.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

						Sincerely,

		

Attachments:
1.  Directive
2.  Record of Proceedi