RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05210
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Fuels Craftsman, medically separated for “recurrent pulmonary embolus” with a disability rating of 0%.  

CI CONTENTION:  “I received 0% rating even though my condition could not be explained by any test.  Since separation I have had pulmonary embolisms again in early 2015.  I have been placed on life-long Coumadin (blood thinner).  I have also continued to have painful problems with my left shoulder.  It often comes out of socket even with physical therapy.”  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 - 20041215	VARD - 20051028	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Pulmonary Embolus…	6817	0%	Recurrent Pulmonary Emboli	6817	60%	20050615	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Recurrent Pulmonary Embolus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s initial pulmonary embolus (blood clot in the lung) occurred in December 2000 and reoccurred in December 2003.  Treatment included anticoagulation medication taken on a daily basis.    

At the 4 November 2004 MEB NARSUM examination, 5 months prior to separation, the examiner noted no current adverse symptoms, and physical findings were detailed and normal.  At the 15 June 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported “some shortness of breath.”  The physical examination was normal and blood oxygen level was documented as 97% on room air.  Oral anticoagulation medication continued in both pre-and-post separation examinations.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pulmonary embolism 0%, coded 6817 (pulmonary vascular disease), citing general VASRD guidelines.  The VA rated the pulmonary embolism 60%, also coded 6817, based on the C&P examination, citing the CI’s requirement for anticoagulant therapy.  Panel members extensively considered the two possible VASRD rating schemes (7121 or 6817) for a vascular condition leading to a situation of an acute or chronic pulmonary embolism and concluded that although code 7121 notes a post-phlebitic syndrome “…of any etiology,” the additional requirement for the presence of a deep vein thrombosis (DVT) was not met.  Therefore, all panel members agreed that VASRD code 6817 accurately reflected the CI’s condition near the time of separation.  A 60% rating stipulates “chronic pulmonary thromboembolism requiring anticoagulant therapy,” and the panel agreed that the STR clearly and consistently documented the CI’s requirement for continued anticoagulation therapy.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 60% for the pulmonary embolism, coded 6817.

BOARD FINDINGS:  In the matter of the pulmonary embolism, the panel recommends a disability rating of 60%, coded 6817 IAW VASRD §4.100-133.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Recurrent Pulmonary Embolism 	6817	60%	

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05210.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.