RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2017-03653
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090228

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, Aviation Warfare Officer, medically separated for “hyper- coagulable state/coagulation disorder” with a 10% disability rating.

CI CONTENTION: “I was required to maintain continual anti-coagulation, which should have rendered the rating 60%.” 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 - 20080728	VARD - 20090325	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hypercoagulable State/Coagulation Disorder	6899-
6817	10%	Hypercoagulable State/Coagulation Disorder S/P Pulmonary Embolism	6817-
7704	10%	20080212	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Hypercoagulable State/Coagulation Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with a pulmonary embolus (PE) in September 2006. This had been preceded in April of that year by a thrombotic coronary event (no residual complications) and he was subsequently diagnosed with a genetic hypercoagulable predisposition. Hematology opined that he should remain on permanent anticoagulation, which was his status at separation. There was no recurrent PE, venous thrombosis, or other complications, and multiple STR provider entries documented that he remained asymptomatic.

At the 11 February 2008 VA Compensation and Pension (C&P) examination, 12 months before separation, the CI denied any systemic symptoms. The physical examination was normal, to include normal cardiovascular findings and normal extremities with no sequelae of thrombosis. The 4 November 2008 MEB NARSUM examination, 4 months prior to separation, detailed the above clinical course and the absence of pain or cardiovascular symptoms. All probative findings on physical examination were normal. The CI acknowledged that he remained asymptomatic in appeal statements after the NARSUM, albeit asserting that it was because he was anticoagulated.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the coagulation disorder 10%, listing code 6899-6817 (analogous to pulmonary vascular disease) on the formal findings document. This was, however, a VA/DOD pilot case and though still rated 10%, the code was corrected on the subsequent PEB formal notification to reflect the VA code 6817-7704 (pulmonary vascular disease rated as polycythemia vera). The VA’s first DES-proposed rating decision conferred a 0% rating under code 6899-6817 via the applicable VASRD §4.100 criterion “asymptomatic, following resolution of pulmonary thromboembolism.” Upon appeal the code and rating was amended to the final VA decision as above. This permitted a rating of 10% via the applicable VASRD §4.117 criterion for code 7704 for “stable, with or without continuous medication.”

The panel agreed that code 6817 is a close clinical fit with this case, although the VA’s analogous 7704 coding criterion was reasonable in light of the requirement for ongoing anticoagulation. Polycythemia vera causes a hypercoagulable state, thus criteria of code 7704 are applicable to the disability attributable to the coagulation disorder component of this case. The next higher 40% rating under code 7704 specifies a requirement for phlebotomy; thus, no rating higher than 10% is supported under those criteria. Other than 7704 and 6817, there are no additional VASRD coding options, analogous or otherwise, that are applicable to this case. The panel then considered whether a higher rating of 30% was supported under criteria of code 6817 for “symptomatic, following resolution of acute [PE].” The evidence established that this criterion was not met.

A key decision, and the CI’s position on appeal, was whether the 60% criteria of code 6817 were supported. These are “chronic pulmonary thromboembolism requiring anticoagulant therapy, or; ... [other criteria not applicable].” The CI asserted, and a possible interpretation is, that permanent (chronic) anticoagulation satisfied those criteria. The VA rating decision, however, directly addressed this issue, stating, “Although you are on anticoagulant therapy [acknowledged as lifelong], the evidence of record does not show that you have a chronic thromboembolism.” Chronic thromboembolism was defined as recurrent emboli that do not resolve. This interpretation was also affirmed in a subsequent VA appeals court decision (Citation # 1212504, Docket 08-14 066, 5 April 2012). The panel thus endorsed this interpretation and agreed that the 60% criteria were not supported since there was no evidence of recurrent or unresolved emboli. 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 hypercoagulable state/coagulation disorder (subsuming PE).

BOARD FINDINGS: In the matter of the hypercoagulable state/coagulation disorder (subsuming pulmonary embolus) and IAW VASRD §4.100 and §4.117, the panel recommends no change in the PEB adjudication (with acknowledgement of de facto application of code 6817-7704 as explained above). 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:

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards
To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
I.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.