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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-2017-04717.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04717
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20060921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Fuels Craftsman, medically separated for “factor V Leiden and recent deep venous thrombosis (DVT) [left lower extremity]” with a disability rating of 0%.

CI CONTENTION:  Review left knee and DVT 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 - 20060714	VARD - 20070403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Factor V Leiden and Recent DVT	7199-7121	0%	Deep Venous Thrombosis	7114-7121	40%	20061127	
Left Knee Pain 	Category II	Residuals, Left Knee 	5299-5259	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Factor V Leiden.  According to the service treatment record and MEB narrative summary (NARSUM), the CI developed a DVT in his left leg shortly after an initial left knee surgery in January 2005 and again after a second surgery on the same knee in May 2006.  Secondary to the first DVT, the CI was hospitalized and started on anti-coagulant therapy (blood thinners) for 6 months.  An extensive laboratory work-up discovered that the CI had a genetic mutation of an anticoagulant protein which placed him at a greater risk to form blood clots in the future, especially when there is a history of trauma, prolonged immobilization, surgery or other significant disease processes.  

During the 18 May 2006 MEB NARSUM examination performed 9 days after the second knee surgery and 4 months prior to separation, the examiner noted the CI was doing well, tolerating Coumadin (anti-coagulation medicine) and the DVT had not affected his job performance.  His physical examination (PE) revealed that the left lower extremity was well healed without swelling, redness, warmth or tenderness.   An unidentified clinical encounter (for a different physical complaint) dated 6 days after separation clearly indicated that the CI was still on oral anti-coagulation medicine and was so on the day of separation.  

At the 27 November 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain in the left thigh that decreased with rest or elevation, and swelling above the left ankle.  The CI was still taking anti-coagulant medication.  His PE revealed a trace amount of non-pitting edema extending 6 inches up from the left ankle.  The left thigh showed no abnormalities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vascular condition 0%, analogously coded 7199-7121 (post-phlebitic syndrome of any etiology).  The VA rated the vascular condition 40%, dual coded 7114-7121 (arteriosclerosis obliterans-post-phlebitic syndrome), based on the C&P examination, citing leg pain relieved with compression stocking and elevation, with presence of trace ankle edema.  The panel first considered the PEB’s analogous primary coding of 7121 IAW VASRD §4.104 (cardiovascular system) and agreed it was a good fit for the medical evidence in this case.  Both pre and post separation examinations cited the continued use of anti-coagulant medication for treatment of the CI’s vascular condition.  Such evidence, coupled with the adverse physical findings at the VA examination, which were controlled with rest or elevation, support an impairment rating no greater than 10%.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the vascular condition, coded 7199-7121.

Contended PEB Condition:  Left Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The CI had two arthroscopic surgeries on his left knee which resulted in the removal of the lateral meniscus in May 2006.  The physical therapy (PT) range of motion (ROM) study of the left knee on 10 July 2006, 2 months prior to separation, revealed decreased and painful motion at 120 degrees flexion (normal 140) and normal extension (0 degrees).  At the VA C&P examination, 2 months after separation, the CI reported left knee pain exacerbated by twisting or improper movements.  Additionally, he endorsed infrequent locking of the knee.  His PE was complete and normal except for occasional crepitus about the left knee.  Clinical testing maneuvers did not show any degree of joint instability.  X-rays of both knees were normal. 

The panel noted that the left knee condition was profiled, implicated in the commander’s statement and judged to fail retention standards.  Members concluded that although the CI’s knee condition appeared to have improved from 2 months pre-separation (noting decreased and painful motion) to the absence of both findings and a near normal PE 2 months post-separation, the continuum healing process at the time of separation would more likely than not support a lesser degree of the originating symptoms.  Furthermore, panel members agreed that such symptoms of limited ROM and any sort of painful motion would support an unfitting condition in an attempt to perform the duties of a fuels craftsman.  Therefore, after due deliberation, the panel agreed that the preponderance of the evidence with regard to the functional impairment of left knee condition favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5259 (cartilage; removal of) and meets the VASRD §4.71a criteria for a 10% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition.
BOARD FINDINGS:  In the matter of the vascular condition, the panel recommends a disability rating of 10%, coded 7199-7121 IAW VASRD §4.104.  In the matter of the contended left knee condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  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	
Factor V Leiden and Recent Deep Venous Thrombosis 	7199-7121	10%	
Left Knee Pain 	5259	10%	
COMBINED	20%	

The following documentary evidence was considered: