RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200460 SEPARATION DATE: 20030923 

BOARD DATE: 20130226 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty CPT/0-3 (66H/Staff Nurse ICU), medically separated 
for superior vena cava (SVC) syndrome, secondary to fibrosing mediastinitis. The CI was initially 
diagnosed in 1998 with fibrosing mediastinitis when she presented with progressive facial 
swelling, and was eventually diagnosed with SVC syndrome. The SVC syndrome did not 
improve adequately with treatment and the CI was unable to meet the physical requirements 
of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a 
permanent P3U3 profile and referred for a Medical Evaluation Board (MEB). The MEB 
forwarded fibrosing mediastinitis, likely secondary to chronic fungal infection with 
histoplasmosis, deep vein thrombosis (DVT), and SVC and right main pulmonary artery (PA) 
stenting conditions to the Informal Physical Evaluation Board (IPEB) for adjudication. No other 
conditions were forwarded by the MEB. The PEB adjudicated the SVC syndrome secondary to 
fibrosing mediastinitis condition as existed prior to service (EPTS) and that it had followed its 
normal progression without permanent service aggravation. The CI appealed to the Formal PEB 
(FPEB), which changed the rating to 30% and placed the CI on temporary disability retired list 
(TDRL) with application of the Department of Defense Instruction (DoDI) 1332.39. However, 
prior to TDRL entry, a Formal Reconsideration PEB changed the rating to 10% for the 
requirement for lifelong anti-coagulation, citing DoDI 1332.39, and determined that she should 
be separated. The CI concurred and made no further appeals. An administrative correction 
was made 2 weeks later without changing either the code or rating. She was then medically 
separated with a 10% disability rating for SVC syndrome secondary to fibrosing mediastinitis. 

 

 

CI CONTENTION: “I was found 10% disabled, though the VA determined that I was 60% due to 
involvement of my pulmonary artery” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. Any conditions or contention not 
requested in this application, or otherwise 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 FPEB – Dated 20030729 

VA *– All Effective Date 20030924 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

SVC Syndrome, Secondary 
to Fibrosing Mediastinitis 

7199-7120 

10% 

Fibrosing Mediastinitis with DVT and 
S/P stenting of SVC and R/Main PA 

6899-6817 

60% 

*STR 

Combined: 10% 

Combined: 60% 



*No C&P Exam’s in Record 

 


ANALYSIS SUMMARY: The Board noted that the records from the admission to the Mayo Clinic 
on 3 May 2002 were incomplete and that the accession history and physical were missing from 
the records in evidence. Efforts to obtain these, including requests directly to the CI, were 
unsuccessful. 

 

Superior Vena Cava Syndrome Condition. On 14 August 1998, she entered active service. On 
7 December 1998, she endorsed a 2 year history of head and neck swelling, varicosities and 
telangiectasias. A chest X-ray showed a small granuloma leading to a CT scan of the chest 
which showed extensive venous collaterals present long term blockage of the SVC the large 
vein returning blood from the upper body to the heart. She was diagnosed with SVC syndrome 
secondary to fibrosing mediastinitis thought to be secondary to histoplasmosis, all prior to 
service. A venogram on 29 December 1998 revealed a critical stenosis of SVC with a 50% 
stenosis of left and right innominate veins. Two days later and 3 weeks after initial 
presentation, she underwent angioplasty of SVC with 50% residual stenosis. She was noted to 
have chronic left subclavian occlusion and a heavily diseased left innominate vein. Two weeks 
later, on 11 January 1999, she underwent SVC and left innominate vein venoplasty. Near 
complete innominate thrombus resolution was noted (she was on anti-thrombotic 
medications). Her symptoms recurred and on 21 April 1999 a repeat venogram showed 
recurrent SVC narrowing (back to baseline) and a stent was placed. The innominate vein was 
now without clot. There are no records of treatment for these conditions in the evidence 
available for review until a CT scan of the chest on 26 February 2002; it showed soft tissue 
infiltration of the mediastinum, especially around the SVC and right PA, and there was concern 
for SVC stent stenosis. At a pulmonary appointment on 13 March 2002, the CI presented with 
recurrent symptoms and noted facial swelling and thorax capillary “swising” (illegible) since 
1996 with a progressive increase from 1996 to 1998. The assessment was of slow progression 
of fibrosing mediastinitis with PA compromise. An echocardiogram on 24 April 2002 showed a 
normal right heart. A week later on 30 April 2002, she presented with a 2 month history of 
dyspnea on exertion with one flight of stairs and increased facial edema if she slept flat. She 
noted that her varicosities were worse. She underwent a repeat venogram with angioplasty of 
the stent stenosis. A pulmonary angiogram showed secondary propagation of clot leading to 
air evacuation to the Mayo Clinic Rochester for management since there was no cardiothoracic 
surgeon at Beaumont. On 2 July 2002, a Chest X-ray showed stents in the right PA and SVC. 
Pulmonary function tests (PFTs) the following month were normal. The narrative summary 
(NARSUM) was dictated on 7 September 2002, a year prior to separation, noted that she could 
perform most tasks as a nurse, but not engage in heavy lifting or physical fitness training. She 
had no complaints of “shortness of breath, cough, wheezing or other airway or thoracic 
complaints.” On examination, she showed no signs of heart failure, but did have varicosities 
below her left breast extending to the epigastrium and right armpit. Her lungs were clear. The 
examiner, a pulmonologist, noted that the February 2002 CT scan showed slow, but definite 
progression in the mediastinal fibrosis since the previous study along with soft tissue infiltration 
around the right PA with marked narrowing to 30% of the original diameter. However, the 
echocardiogram, done to assess the significance of this narrowing, was normal. The NARSUM 
noted that a stent was placed in the PA due to concerns about further compromise from 
progressive (mediastinal) fibrosis. The NARSUM also noted that, 3 months after the admission 
to Mayo, a repeat CT scan showed improved right main PA flow secondary to the new stent and 
a slight decrease in mediastinal fibrosis (from the prior study). No comparison was made 
between this CT and the initial CT scan in December 1998. There was not a VA Compensation 
and Pension exam before or after separation. In addition, there were no further clinical visits in 
the record in evidence after the NARSUM until separation. However, there were numerous 
communications between the PEB and different medical consultants regarding service 
aggravation of the EPTS condition. The consensus was that it cannot be established if the 
failure to discontinue Oral Contraceptive Pills, delay in anti-coagulation initiation and lapse in 
activity restriction aggravated her disability and, therefore, she should be given the benefit of 
the doubt in this consideration. 


The Board directed its attention to the rating recommendation based on the above evidence. 
The PEB rated the CI at 10% and coded it as analogous to 7120, varicose veins. The VA rater, 
using the same information, awarded a 60% disability rating coded analogously to 6817, 
pulmonary vascular disease. The Board noted that at the time of the NARSUM, the CI had no 
pulmonary complaints and had no edema. The varicosities present on examination had been 
present since 1996 per the CI’s history at presentation in 1998. The Board noted that while 
there was a PA stent placed and narrowing of the PA from soft tissue surrounding it, the record 
does not show a thrombus (clot) in the PA; rather, there was thrombosis in the SVC and 
innominate veins. The Board considered the code 6817 utilized by the VA and determined that 
this did not fit the clinical picture as the PA was not involved with clot, and that she did not 
have vascular disease of the lungs or chronic pulmonary thromboembolism. The 
echocardiogram and PFTs were normal which is consistent with the diagnosis of mediastinal 
disease rather than pulmonary disease. The clear preponderance of the evidence establishes 
that the veteran did not met the criteria for a 60% evaluation under DC 6817 at any time 
following her discharge, since the criteria for that evaluation requires a medical diagnosis of 
chronic pulmonary thromboembolism or surgery of the inferior vena cava. Neither was 
present. The PEB utilized the code of 7120, varicose veins. These clearly were present and 
were secondary to the long standing SVC syndrome, secondary to fibrosing mediastinitis; both 
conditions clearly were EPTS conditions. The Board reviewed the records and was unable to 
ascertain if the condition had, in fact, worsened or even improved from accession, but noted 
that the findings clearly waxed and waned depending on treatment. Regardless, the PEB 
conceded potential service aggravation and did not determine an EPTS deduction, rendering 
the consideration moot. No edema was present, but the varicosities were and had been 
present since 2 years prior to accession without recorded resolution. The Board determined 
that the best fit to the clinical picture was the description of the 20% disability rating, persistent 
edema, incompletely relieved by elevation of extremity, with or without beginning stasis 
pigmentation or eczema. After due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 20% 
for the SVC 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. As discussed above, PEB 
reliance on DoDI 1332.39 for rating the SVC syndrome was operant in this case and the 
condition was adjudicated independently of that instruction by the Board. In the matter of the 
SVC syndrome condition, the Board unanimously recommends a disability rating of 20%, coded 
7199-7120, 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 her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Superior Vena Cava Syndrome Secondary to Fibrosing Mediastinitis 

7199-7120 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20030923, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXXXXXX, AR20130004075 (PD201200460) 

 

 

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 20% 
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 XXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)