RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03896
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20091123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Structural Maintenance Craftsman, medically separated for “history of recurrent deep vein thrombosis [DVT] of the leg” with a disability rating of 10%.   

CI CONTENTION:  “Factor V. Air Force never heard of it.  Depression and other long list of medical issues.  I take blood thinners the rest of my life.  Have to wear compression socks.”  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 - 20090819	VARD - 20100316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Recurrent DVT of the Leg	7121	10%	Left Leg DVT	7199-7121	0%	20091001	
Factor V Leiden	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

History of Recurrent DVT of the Leg.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s DVT condition began in 1993 during the pregnancy of her first child.  She was treated with anti-coagulants.  Genetic evaluation and testing in approximately 2002, showed the presence of Factor V Leiden, likely inherited from her mother who had a mild form of Factor V Leiden (a genetic variant found in 3-5% of Caucasians and associated with greater risk of thrombosis.)  The 5 November 2008 Doppler (ultrasound) study of the left leg was consistent with DVT involving the left common and superficial femoral veins.  The 5 December 2008 physical examination showed normal right and left legs with no edema but slight tenderness of the medial thigh over the DVT location.   

The 23 December 2008 MEB NARSUM examination, 11 months prior to separation, noted the CI suffered no recurrence until February 2008 when she experienced a “restless legs” discomfort that worsened over several months.  She was examined in hematology/oncology and indefinite anticoagulation therapy was recommended.  Her latest international normalized ratio was 2.4 during December 2008 (moderate 2.0-3.0).  She was also strongly advised to attend smoking cessation.  She was unable to continue in her military specialty due vulnerability of cutting herself in the performance of her duties.  She was restricted in her fitness program until the clot resolved.  The NARSUM examination referenced the above physical findings.  The 13 January 2009 commander’s statement noted that as a result of her condition and medications, the CI was unable to perform her duties and had been reassigned to administrative tasks. The 29 June 2009 emergency room (ER) visit noted CI complaint of her leg giving out; however, examination of the leg was normal.  The August 2009 SAF/MRBP response noted the MEB physical examination was normal other than “slight tenderness over location of the DVT.”  There was no edema noted.  The SAF concurred the 10% disability rating was appropriate.

At the 1 October 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported leg pain after prolonged standing and walking.  She reported edema of the leg that occurred intermittently and was not relieved by foot elevation or compression hosiery.  There was dark pigmentation of the skin.  She was treated with an anti-coagulant.  She reported overall functional impairment was less activity.  Physical examination showed no evidence of ulceration, edema, or stasis dermatitis in the bilateral extremities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DVT condition 10%, coded 7121 (post-phlebitis syndrome of any etiology), citing a hyper coagulation state; Factor V Leiden, requiring Coumadin therapy. The VA rated the DVT condition 0%, analogously also coded as 7121 based on the C&P examination, citing no evidence of intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery.  

Neither the NARSUM nor the C&P examinations showed evidence of edema. The C&P examination more proximal to separation noted edema of the leg occurred intermittently and leg pain occurred after prolonged standing and walking.  The panel noted there was no evidence of persistent edema and/or pigmentation of the skin to meet criteria for a rating higher than the 10% assigned by the PEB.  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 hypercoagulation state with history of DVT condition.

Contended PEB Condition:  Factor V Leiden.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was implicated in the commander’s statement.  The PEB noted, “manifestations of Factor V Leiden may be ratable but not the condition itself.”  The condition was not noted on limited duty forms, or non-medical assessment, and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the deep vein thrombosis condition and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  In the matter of the contended Factor V Leiden condition, the panel agrees it cannot recommend it for additional disability rating.  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.  

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

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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-2017-03896.

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.