RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2022-00034
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Support Specialist, medically separated for “recurrent deep vein thrombosis (left lower extremity [LLE]…right cephalic)” with a disability rating of 0%.   

CI CONTENTION:  Review requested of her veinous condition and low back pain, as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20040603	VARD - 20041208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Deep Vein Thrombosis LLE…Right Cephalic)	7199-7121	0%	Deep Vein Thrombosis LLE	7114	0%	20040913	
Low Back Pain	Not Unfitting	Degenerative Disc and Joint Disease, Lumbar Spine	5242	20%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Recurrent Deep Vein Thrombosis (DVT).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced an LLE DVT in 2001, which was thought to be due to a history of gastrocnemius muscle injury.  She was hospitalized at that time and
treated with a 4-month course of coumadin (anticoagulant).  She had a second DVT in the right upper extremity (RUE) in 2002 during her first trimester of pregnancy and was put back on coumadin indefinitely.

During the January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported continued treatment with coumadin.  There was no report of LLE or RUE edema, pain, tenderness, or fatigue after prolonged standing, walking, or use of the arm.  Physical examination showed normal upper and lower extremities with no swelling.  

The 14 April 2004 MEB NARSUM examination, 3 months before separation, noted CI complaints of recurrent DVT requiring chronic anticoagulation therapy.  The examiner referred to a January 2004 hematology consult that found no etiology for the DVT after an extensive hypercoagulable workup was negative. The hematologist recommended anticoagulation treatment indefinitely due to the CI’s history of recurrent DVT.  Physical examination of all extremities demonstrated normal pulses and vascularization with no edema.  The MEB examiner opined that due to her chronic need for anticoagulation medication and the associated risk of bleeding from even minimal trauma, the CI had significant functional limitations which would not allow her to perform her duties or deploy.

A pain management treatment entry from 19 April 2004 noted the CI was being seen for intermittent low back pain using behavioral management techniques.  There was no mention of RUE or LLE pain.  

At the 13 September 2004 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported a history of recurrent DVT and the chronic need for coumadin.  She had left calf swelling 1-2 times a week that was “benign and self-limited,” and could walk up to a mile despite chronic knee pain.  She did not mention any upper extremity symptoms.  Upon examination, there were no RUE or LLE abnormalities, except for the right knee, which showed signs of arthritis but had normal range of motion (0-140 degrees).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DVT 0%, analogously coded 7121 (post-phlebitic syndrome of any etiology), citing no residual clinical findings associated with the condition.  The VA also rated the DVT 0%, coded 7114 (arteriosclerosis obliterans), based on the C&P examination, citing a noncompensable evaluation.  The panel first noted that the VA rating schedule does not have a designated code for DVT, and thus, agreed that analogous use of code 7199 was appropriate.  A compensable rating under this code is granted for intermittent edema, aching or fatigue of the extremity after prolonged standing or use.  Panel members noted that while the CI complained of intermittent calf swelling from the DVT, but she did not endorse any other symptoms associated with the condition.  Additionally, she did not report the calf swelling on the DD Form 2807 or mention it during the MEB NARSUM examination.  Neither the MEB or C&P examiner documented edema and there were no other STR entries recording DVT symptoms.  The panel agreed that the evidence demonstrated the recurrent DVT had been successfully treated with the sustained anticoagulation therapy.  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 DVT.  

Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended low back condition was not unfitting.  This condition was profiled P2 with restrictions on running and sit-ups; however, the condition was not implicated in the commander’s statement 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 DVT and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  In the matter of the contended low back pain, 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20220411, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record]

AR20230002068, XXXXXXXXXX 

XXXXXXXXXX

Dear XXXXXXXXXX:

	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.