RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04564
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Human Intelligence Collector, medically separated for “chronic iron deficiency anemia” with a disability rating of 10%.  

CI CONTENTION:  Review requested of all conditions as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20061215	VARD - 20080710	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Iron Deficiency Anemia 	7700	10%	Anemia	7700	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Iron Deficiency Anemia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s anemia began secondary to menorrhagia from submucosal fibroids in 2002 after changes in her menstrual cycle (spotting between periods and heavier menstruation).  She started to feel weak and was seen and treated for anemia with oral contraceptives and iron supplements, but her “stamina would wax and wane depending on how low her blood count got.”  In early 2006, she became intolerant of intravenous iron supplements.  A gynecologic evaluation, which included review of an October 2006 transvaginal ultrasound and November 2006 hysterosonography, led to the diagnosis of submucosal fibroids as the likely cause of abnormal menstrual bleeding and anemia.  Surgery was considered, however, given the CI’s age and desire to have children, oral contraceptives were provided to allow a menstrual cycle every 3 months.  

The 1 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808) and MEB NARSUM, 2 months prior to separation, noted complaints of low blood counts and constant fatigue.  The CI reported chronic anemia secondary to heavy menstrual cycles that required her to stand up slowly or she would became dizzy or lightheaded.  Physical examination revealed a soft abdomen with normal bowel sounds, but “mild tenderness left lower quadrant (chronic from ovarian cyst).”  The 16 October 2006 hematocrit results show 27.3 (37-47 normal) and hemoglobin at 8.3 (12-16 normal), with improved results on 9 November 2006 showing hematocrit of 33 and hemoglobin of 10.5.  The examiner stated the CI had to be removed from her platoon sergeant position because she was “physically unable to keep-up with her troops due to her anemia.”  A hysterectomy was recommended as the ultimate treatment to resolve symptoms, but the examiner stated the condition would likely remain a problem “given her desire to maintain fertility.”  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 anemia 10%, coded 7700 (anemia), citing hemoglobin of 10.5 and persistent fatigue.  The VA rated the anemia 0%, also coded 7700, based on the STR, citing hemoglobin recorded as 10gm/100ml or less with no symptomatology.  Panel members considered ratings under VASRD §4.117 (hemic and lymphatic systems) and/or §4.116 (gynecological conditions and disorders of the breast).  However, there was no evidence of hemoglobin of 8gm/100ml or less proximate to separation for the next higher rating under code 7700, and no displacement or prolapse of the uterus or adhesions for alternative or additional higher rating under any VASRD §4.116 coding.  The panel also considered whether the PEB’s adjudication was for two bundled unfitting conditions; however, the menorrhagia diagnosis was intrinsic to the rated iron deficiency anemia.  Separating the conditions, if both were separately unfit, would be at 0% each.  Given that a 10% PEB rating was reasonable for the combined conditions, a separate rating above 0% could not be supported without pyramiding (VASRD §4.14); thus, both conditions are appropriately subsumed under the same rating.  There was therefore no available VASRD rating higher than that adjudicated 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 anemia condition.  

BOARD FINDINGS:  In the matter of the anemia and IAW VASRD §4.116 and §4.117, 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:

AR20190007320, XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.