RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2018-00007
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20030905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Computer Systems Operator, medically separated for “hypercoagulability” with a disability rating of 10%.  

CI CONTENTION:  “At the time of medical separation, final disability rating for Diagnostic Code 7703 myelodysplastic syndrome percentage was 0%. On April 30, 2014, Diagnostic Code 7703 myelodysplastic syndrome progressed and VA percentage increased to 100%.  Furthermore, I was required to pay back my after tax severance pay amount of $21,388.50.  I would like to be reimbursed the entire $21,388.50.”  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 - 20030701	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hypercoagulability Secondary to Anticardiolipin Antibody Syndrome and Acquired Activated Protein C Resistance	7704-7799	10%	No VA Examination Proximate to Separation in Evidence	
Myelodysplastic Syndrome	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Hypercoagulability Secondary to Anticardiolipin Antibody Syndrome and Acquired Activated Protein C Resistance.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s hypercoagulability condition began in August 2002 with complaint of left leg pain and swelling.  He presented to the emergency room and was diagnosed with idiopathic deep vein thrombosis (DVT).  Lab studies showed a mild macrocytic anemia.  Ultrasound on 11 September 2002 showed a non-compressible clot in the distal common femoral vein throughout the superficial vein and part of the popliteal vein.  He was started on medication and referred to hematology/oncology for further evaluation.  Bone marrow biopsy showed evidence of myelodysplastic syndrome.  

The 22 October 2002 MEB NARSUM examination, 10 months prior to separation, noted complaints of mild left lower extremity (LLE) edema, without lower extremity pain, chest pain, shortness of breath, dizziness or fatigue.  He was asymptomatic from the DVT with exception of mild LLE edema.  Lab studies showed red cell hyperplasia.  Physical examination showed normal vital signs with trace 1+ pitting edema.  The examiner noted the CI should have no functional impairment based on his diagnoses of myelodysplastic syndrome or mild anemia at this point.  He worked largely with computers and there should be no difficulty with this type of work but he should be limited to light duty and not considered worldwide qualified until he completed anticoagulation therapy and hypercoagulation work-up.  He required frequent monitoring to ensure he was on the appropriate dose of Coumadin.  

The 1 November 2002 MEB NARSUM addendum noted after completion of 6 months of anticoagulation therapy with Coumadin, an evaluation for a hypercoagulable state was undertaken which revealed anticardiolipin antibody syndrome and acquired activated protein C resistance.  He was restarted on Coumadin and required anticoagulation indefinitely.  He was doing very well and had no new blood clots since September 2002.  There had been no bleeding or bruising.  He returned to working with computers.  Physical examination showed 1+ edema in the LLE unchanged from previous examination and no other signs of swelling.  He required frequent monitoring of INR (international normalized ratio with respect to bleeding time) to maintain the appropriate Coumadin level; he also required regular 3-6 month follow-up to ensure he was not having significant problems related to the medication or to recurrent thrombotic events.  

The 18 February 2003 outpatient hematology/oncology clinic visit noted the CI reported a decrease in swelling of his left calf.  There was intermittent swelling that worsened with walking but resolved with elevation.  He denied pain in his leg.  There was no chest discomfort, shortness of breath, fevers, chills, night sweats, or weight loss.  Further testing was ordered to determine if the CI needed any further Coumadin therapy.  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 hypercoagulability condition 10%, analogously coded 7704 (polycythemia vera), citing the requirement for Coumadin.  The PEB also adjudicated myelodysplastic syndrome as a Category II condition (can be unfitting but not currently compensable or ratable), analogously coded as 7703 (leukemia).  

The NARSUM addendum noted the CI was doing very well, had no new clots since September 2002, and had returned to work.  The last clinic visit noted again there were no signs of clots and lab studies would determine if further Coumadin therapy was required.  There was no evidence of the need for phlebotomy or other therapeutic interventions beyond medication under the analogous 7704 coding.  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 hypercoagulability condition.  

BOARD FINDINGS:  In the matter of the hypercoagulability condition and IAW VASRD §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.  

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00007.

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.