RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01058
BRANCH OF SERVICE:  Army	BOARD DATE:  20150217
SEPARATION DATE:  20051001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 1LT (Health Services) medically separated for deep vein thrombosis (DVT).  The DVT could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The DVT condition, characterized as “recurrent left lower extremity DVT,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “deep vein thrombosis, left lower extremity with pulmonary embolism (resolved)” as unfitting, rated 20%.  The CI waived her right to a Formal PEB, but submitted a written appeal.  The IPEB decision was upheld and the CI was medically separated.

CI CONTENTION:  “Unfit rating was given for underlying effect of not the cause.  I was diagnosed with antiphospholipid antibodies (APLAs) which cause my blood to clot resulting in lifelong anticoagulation therapy.  In addition, approximately 7 months after separation, I was diagnosed with Non-Hodgkin’s Lymphoma found to be service connected by the VA.  My medical records from the Army will show biopsy of lymph nodes.”

His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20050623 | VA - (~2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Deep Vein Thrombosis | 7121 | 20% | Recurrent DVT, Left Lower Extremity with Spider Veins | 7199-7121 | 0%* | 20051118
Other x 0  (Not in Scope) | Other x 2
Rating:  20% | Rating:  0%
Derived from VA Rating Decision (VARD) dated 20060215 (most proximate to date of separation [DOS]).
* VARD 20061024 increased rating to 10% effective 20051002 (day after DOS)
ANALYSIS SUMMARY:

Deep Vein Thrombosis Condition.  The narrative summary (NARSUM), dated 5 months prior to separation, noted that the CI had two distinct episodes of pulmonary emboli (blood clots to the lungs) with complete resolution of symptoms and without pulmonary or cardiac disease.  This was followed by recurrent (and chronic) DVT of the left lower extremity (LLE) confirmed by imaging.  These episodes were associated with pain and swelling of the LLE with marked but incomplete improvement between episodes.  The NARSUM exam stated that the LLE was 1 inch larger in diameter than the right due to swelling but the overlying skin appeared normal.  Lab testing indicated that the CI was positive for the Lupus Anticoagulant antibody (associated with thrombosis but is not considered hereditary).  At the MEB examination performed 4 months prior to separation; the CI stated she had “recurrent pain and leg swelling, left extremity one inch larger than [the] right, varicose veins…”  The provider stated that the CI was “currently stable and asymptomatic” with “normal” marked under skin and lymphatics, with no comments regarding varicose veins, eczema, ulceration or pigmentation of the extremity.  Per the commander’s statement, the CI underwent 1 day of hospitalization and 3 days of physician prescribed quarters for her leg thrombosis.

At the VA Compensation and Pension exam performed a month after separation, the CI denied chest pain or shortness of breath.  The examiner noted that the CI had a normal lung and cardiac exam and the CI was walking without limp or assistive device.  There was no lower extremity edema and DVT symptom testing (Homan’s) was negative bilaterally.  Skin exam did not show any non-healing ulcers, or eczematous patches.  There were “faint, slight, only spider veins… with no varicose veins.”  The CI was using a support stocking.  No measurements of the extremity were performed.

The Board directed attention to its rating recommendation based on the above evidence.  Under an analogous code 7121 (post-phlebitic syndrome of any etiology), the PEB assigned a 20% rating for persistent edema, incompletely relieved by elevation of [the] extremity, with or without [skin changes].  There was no prior history of vascular problems to support this condition as having existed prior to service.  The VA’s initial 0% rating was increased to 10% within the year based on reasonable doubt.  Board members agreed that there was no evidence supporting a compensable rating under code 6817 (Pulmonary Vascular Disease - Chronic Pulmonary Thromboembolism) as there was no evidence of lung or cardiac dysfunction.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the DVT 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 condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record
Exhibit D.  Air Force Consultant Communication, dated 20130123

XXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150007425 (PD201301058)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01058