RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1201644	SEPARATION DATE:  20040312
BOARD DATE:  20130417

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SSG/E-6 (88M30/Truck Driver), on a temporary tour of active duty, medically separated for recurrent deep vein thrombosis (DVT). hypercoagulation syndrome, necessitating life-long anticoagulant therapy, without edema or pain.  While deployed to Kuwait, driving trucks on multi-day runs in combat conditions to Baghdad, he noticed his right leg swelling.  Ultrasound evaluation disclosed blood clots.  He was medically evacuated to Germany en route to CONUS.  While at Walter Reed Army Medical Center he was worked up for coagulopathy, but after arriving at Ft Knox his symptoms resolved.  The CI had had previous DVT in 1993 and 1997.  The CI was at noticeable increased risk for recurrence and placed on lifelong Coumadin anticoagulation medication.  The CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3/E3 profile and referred for a Medical Evaluation Board (MEB).  The MEB also identified and forwarded deafness, identified in the rating chart below, as a condition which existed prior to service (EPTS) and was not permanently service aggravated (PSA).  The Physical Evaluation Board (PEB) adjudicated the recurrent DVT hypercoagulation syndrome, necessitating life-long anticoagulant therapy condition as an impairment that was EPTS, but subsequently PSA, unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB also determined the CI’s deafness to be not unfitting and not ratable.  The CI made no appeals, and although he was eligible for transfer to the retired reserve he elected to be separated with disability severance pay and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB.  The unfitting DVT, hypercoagulation syndrome needing lifelong anti-coagulant therapy without edema or pain meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below.  No other conditions are within the Board’s purview.  Any condition outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20031021	VA – All Effective Date 20040312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DVT; Hypercoagulation Syndrome	7121	0%	Hypercoagulation Syndrome	7705-7704	10%	STR	
			Recurrent DVT Rt Lower
Extremity	7199-7121	0%	STR	
Deafness	Not Unfitting	Tinnitus	6260	10%*	20040804	
↓No Additional MEB/PEB Entries↓	0% X 2* (Includes Above) / Not Service-Connected x 0	STR	
Combined:  0%	Combined:  20%*	
*Original VARD 20040427 deferred ratings for hearing loss and tinnitus; VARD 20040827 added tinnitus at 10% & hearing loss at 0%, and increased the combined rating from 10% to 20%.  

ANALYSIS SUMMARY:  

Recurrent Deep Vein Thrombosis. Hypercoagulation Syndrome, Necessitating Life-Long Anticoagulant Therapy, without Edema or Pain Condition.  The CI first sustained a DVT in 1993 after open reduction of a fracture of the dorsal (thoracic) spine.  He had additional DVTs in 1997 and during his military deployment.  The DVT resolved on anticoagulants (Coumadin) as demonstrated by ultrasound exam in August 2003.  The narrative summary (NARSUM) physical exam of extremities August 2003 noted no edema and no need for hose stockings.  The CI was able to walk with good transition between standing to sitting and sitting to standing.  He was taking Coumadin daily with blood clotting levels in the therapeutic range, and was committed to lifetime anticoagulation therapy.  The NARSUM indicated a pending coagulation evaluation and results of the evaluation indicated decreased Factor S and recommended a repeat study.  (Factor S deficiency is a hereditary hypercoagulable condition, predisposing to DVT).  DD Form 2808, Report of Medical Exam, in August 2003 documented right calf circumference of 41 cm compared to 38 cm on the left.  The commander’s statement dated 8 October 2003 indicated “chronic leg pain in in his right leg” made the CI incapable of performing his.

No VA Compensation and Pension (C&P) exam for this condition was performed; the VA rated the CI’s condition based on the MEB and service medical records.  The Board carefully considered all of the evidentiary information available.  The PEB rated the recurrent DVT and hypercoagulation syndrome condition at 0% coded 7121 (Post-phlebitic syndrome of any etiology [DVT]) and stated there was no edema or pain.  The VA, using the same exam information rated the DVT and hypercoagulation syndrome as two conditions: recurrent DVTs coded 7199-7121 at 0%; and hypercoagulation syndrome coded 7705-7704 (thrombocytopenia, primary, idiopathic or immune and polycythemia vera) at 10%.  The Board deliberated if the recurrent DVTs, increase calf circumference, and commander’s statement of chronic leg pain warranted a 10% rating under code 7121 for “intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery” and/or if an additional 10% rating for the hypercoagulation syndrome (following the VA coding) was warranted IAW DOD and EPTS guidelines.  After due deliberation, and mindful of VASRD §4.3 (reasonable doubt), and §4.7 (higher of two evaluations), the Board recommends a disability rating of 10% for the DVT and hypercoagulation syndrome condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the DVT, hypercoagulation syndrome condition, the Board unanimously recommends a disability rating of 10%, coded 7121 IAW VASRD §4.104. There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
DVT, Hypercoagulable Syndrome	7121	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120727, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130010316 (PD201201644)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA