Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01365
Original file (PD2012 01365.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1201365
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130801
DATE OF PLACEMENT ON TDRL: 20030330
Date of Permanent SEPARATION: 20060818


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was in the Training of Active Reservists (TAR) (reservist on active duty), IC1/E-6 (Interior Communications) medically separated for deep venous thrombosis (DVT) of the left lower leg. The CI had a lengthy history of broken service during which he was diagnosed with DVT. The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The DVT condition, characterized as “deep venous thrombosis, lt. superficial femoral vein” was forwarded to the Physical Evaluation Board (PEB). No other conditions were submitted by the MEB. The PEB adjudicated “deep venous thrombosis, left superficial femoral vein” as unfitting, rated 40% and placed the CI on the Temporary Disability Retired List (TDRL). The CI made no appeals. Subsequently after two TDRL periodic exams, the PEB determined the CI’s left lower leg DVT to be stable and unfitting and at this time also determined the CI’s condition to be “post phlebitic syndrome” rated 10%. In addition, the PEB determined the CI’s “deep venous thrombosis, left superficial femoral vein, resolved” as a Category II condition, contributing to the unfitting Category I post phlebitis syndrome. The CI made no appeals and was permanently separated.


CI CONTENTION: “Per the findings of my Physical Evaluation Board Proceeding dated 17 Nov 2002, my combined disability rating was rated at 40% category I unfitting conditions. Under HR 1538, the Wounded Warriors Legislation I am requesting a review of my discharge to medical retired.” The CI continued in block 15 of the application: “I’m a disabile Vet that has been hospitalized on numberous occaction because of my disabilities. My VA Medical Records will attest to this, it is hard for me to sustain employment which makes it hard to support my family medical and daily needs.”


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 when specifically requested by the CI. The rating for the unfitting DVT, left leg condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.


RATING COMPARISON:

Final Service PEB - 20060623
 VA (36 Mo. Prior to Adjudication Date*) - Effective 20030330
On TDRL - 20030330
 Code Rating Condition Code Rating Exam
Condition
 TDRL Sep.
Post Phlebitic Syndrome
 7121 40% 10% Deep Vein Thrombosis, Left Femoral Vein 7121 20%* 20030705
Deep Venous Thrombosis
 Cat II
No Additional MEB/PEB Entries.
 Other x 2 20030605
Combined: 40% → 10%
 Combined: 30%*
*Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation. NOTE: Decision Review Officer decision 20031024 granted code 7121 at 20% disabling from 2 0030330. Initially, the VA did not service connect the DVT condition (original VARD dated 20030903 pertains) , but instead rated code 7121 at 0% for varicose veins, left leg from 20030330 (combined rating 10%) .


ANALYSIS SUMMARY:

Post Phlebitic Syndrome, Left Leg. The CI had a postoperative DVT in 1996 after surgery for a gunshot wound to the lower abdomen for which he was treated with 18 months of Coumadin anticoagulation treatment. On 8 February 2001, he was hospitalized for a 5 week history of left foot numbness and tingling, and an ultrasound was positive for an acute venous thrombosis involving the superficial femoral at the level of the bifurcation to just above, not including the popliteal vein. This was determined to be a recurrence of the prior venous thrombosis, so lifelong Coumadin anticoagulation was recommended. On 22 February 2001, he got a physical profile restriction on hazardous duty, contact sports, exposure to significant injury, no ship duty, and access to regular monitoring of lab values and access to medical care. A repeat ultrasound on 24 October 2001 found the clot (thrombus) still had not resolved. After a period of limited duty, the CI was placed on the TDRL with a 40% rating on 17 November 2002. The clot had resolved by 22 July 2004 ultrasound testing. On 22 October 2004, TDRL was again recommended because he was hospitalized for low anticoagulation values, and deemed not yet stable for adjudication. He remained on the TDRL for approximately 4 years, until 23 June 2006. On the MEB to TDRL NARSUM examination on 31 July 2002, physical examination revealed no cyanosis or clubbing, no edema, normal dorsalis pedis pulses, 7 cm cord like mass in the posterior aspect of the distal left thigh, and a 1 cm nodule (later found to be a Morton’s neuroma) of the plantar aspect of left foot between the 4th and 5th toes with decreased soft sensation between the 4th and 5th toe extending to the lateral foot, and diminished deep tendon reflexes. At the VA Compensation and Pension exam performed on 5 June 2003, 36 months prior to separation, the CI reported he was on Coumadin, and he reported swelling of the leg, development of varicose veins of the leg and shin. Skin examination was normal, no tenderness, no separation, no edema, peripheral pulses were present, no sensory or motor deficits, the left calf was swollen compared to the right calf, varicose veins of the left leg on the shin and the posterior thigh in the popliteal areas which were compressible, tenderness on the medial side of the femoral vein area in the thigh on the left side. At the first periodic TDRL examination, on 21 September 2004, the CI had one recent prior hospitalization to get his international normalized ratio back to therapeutic levels with Lovenox and Coumadin in August 2004. The CI had complaints of swelling, aching, and pain of the left lower extremity from time to time, if he was on his feet for too long or his feet were hanging for too long. He tried to elevate his feet from time to time. He was active with stationary biking for exercise, doing household work, and he was a full time student. Physical extremities revealed tenderness of thigh and calf, left lower extremity bigger than the right particularly around the thigh, knee, and calf, very engorged varicose veins that were tender to palpation and not red or warm. He had trace edema round his left ankle, intact pulses, intact neurologically. At the second, and last, TDRL physical examination on 27 April 2006, 4 months prior to separation, the CI complained of pain and swelling of the left leg several days out of the week. Usually pain accompanied the swelling, which generally occurred with prolonged walking and standing; he took no medications for the pain, but lied down and elevated his leg, he sometimes wore a compression stocking. The CI reported he tried not to stand for too long because he knew it would bring on swelling and pain. Physical examination revealed a 44 cm right calf and a larger 47 cm left calf, with prominent left varicosities over the medial and posterior left thigh and calf, trace pitting pretibial edema on the left, no ulcerations, normal pulses and hair growth, with normal neurological and motor function. The CI was a full time college student at the time.

The Board directs attention to its rating recommendation based on the above evidence. The Board first turned its attention to the entry into TDRL rating. The PEB used the Veterans Affairs Schedule for Rating Disabilities (VASRD) diagnostic codes 7199 (rated analogous to) 7120 (varicose veins) which is rated with the same criteria descriptors as 7121 (post-phlebitic syndrome of any etiology [DVT]) for a 40% rating on 17 November 2002. The Board found no evidence in the record of persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration for a higher adjudication of 60%, and by caveat, the Board may not recommend a lower TDRL rating than the 40% assigned by the IPEB. The Board then turned its attention to a rating at the time of separation. The Board agreed that the second TDRL examination most proximal to separation was the most probative for adjudication. Both the PEB and the VA used the same code: 7121, with the PEB rating the condition 10% and the VA rating it at 20%. The Board found evidence of intermittent pain and swelling reported by the CI several times during the week, exacerbated by prolonged walking and standing, and that he would elevate the limb or use compression hosiery, meeting the 10% rating criteria. There was no reported persistent edema, incompletely relieved by elevation or beginning stasis pigmentation or eczema for a higher 20% rating. 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 left leg 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 left leg condition and IAW VASRD §4.104 (cardiovascular system diseases of the arteries and veins) 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Left Leg Post Phlebitic Syndrome
 7121 40% 10%
COMBINED
 40% 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120723, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review








MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 17 Dec 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXXXXX former USN


                                                      XXXXXXXXXXXXXXXXXX
                                                     Assistant General Counsel
                  (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2011 | PD2011-01024

    Original file (PD2011-01024.docx) Auto-classification: Denied

    The conditions of history of deep vein thrombosis of the right and left lower extremities with post-phlebetic syndrome and chronic venous insufficiency as requested for consideration are the residuals that, IAW with the VASRD, should be used to rate the unfitting condition of heterozygous factor V Leiden deficiency and therefore they meet the criteria prescribed in DoDI 6040.44 for Board purview; and are addressed below, as part of the review of the rating for the unfitting condition. ...

  • AF | PDBR | CY2014 | PD-2014-01176

    Original file (PD-2014-01176.rtf) Auto-classification: Approved

    Repeat examination on 27 June 2004 also recorded that there was no edema of the lower extremities. On examination, the left calf and both thighs were tender to touch, and several distended veins were felt on the left lower calf and right upper thigh.A Coumadin Clinic encounter on 9 December 2005, recorded the CI experienced muscle pain when he overdid activities such as standing too long or playing basketball. The CI complained of edema of the lower extremities relieved with elevation on...

  • AF | PDBR | CY2011 | PD2011-00113

    Original file (PD2011-00113.docx) Auto-classification: Approved

    The CI made no appeals, and was medically separated with a 10% disability rating. In 2008, the VA further increased this rating to 40% effective on 31 March 2004 based on evidence from continuing treatment records and a later VA C&P examination in May 2008. I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.

  • AF | PDBR | CY2009 | PD2009-00559

    Original file (PD2009-00559.docx) Auto-classification: Denied

    There were no trophic skin changes or evidence of stasis dermatitis.” Diagnosis was “Postphlebitic syndrome, left lower extremity.” The VA (near entry into TDRL) used essentially the same exams and history as the military and rated the CI’s DVT-related conditions as 7121 (Left Lower Extremity Deep Venous Thrombosis) at 10%, and 6817 (Bilateral Base Pulmonary Emboli Secondary to Deep Venous Thrombosis) at 60%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3...

  • AF | PDBR | CY2009 | PD2009-00157

    Original file (PD2009-00157.docx) Auto-classification: Denied

    Chronic, Persistent Deep Venous Thrombosis/Recurrent Pulmonary Embolism/Hypercoagulable State requiring chronic use of anticoagulants: The CI served in the U.S. Marine Corps between 1987 and 1991 on active duty. VA treatment records revealed that in January 2009, the CI was admitted for another pulmonary embolism. Either condition alone would require Coumadin use.

  • AF | PDBR | CY2013 | PD2013 00864

    Original file (PD2013 00864.rtf) Auto-classification: Denied

    SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (3381/Food Service Specialist) medically separated for recurrent deep venous thrombosis (DVT).The CI reportedly had his first episode of DVT (a clot in a large leg vein), left lower extremity (LLE), in 1985. The Board determined that the DVT in either leg, in the presence of the requirement for lifelong anti-coagulation, was separately unfitting and...

  • AF | PDBR | CY2014 | PD-2014-02239

    Original file (PD-2014-02239.rtf) Auto-classification: Denied

    The initial VA C&P examination (within the DES Pilot process occurred)dated3 June 2009, during the examination, the examiner noted that the CI was not currently in psychiatric treatment and during brief treatment for his MH symptoms in 2008 he was not hospitalized, was not suicidal and had not required any psychotropic medications.At the VA C&P examination the CI denied being anxious or depressedand the examiner noted the CI was “without signs of ongoing anxiety, depression, or psychosis at...

  • AF | PDBR | CY2011 | PD2011-00663

    Original file (PD2011-00663.docx) Auto-classification: Denied

    Although the pulmonary scans and pulmonary hypertension were improving, the CI had continued shortness of breath and had a diagnosis of chronic thromboembolic disease. The Physical Evaluation Board (PEB) adjudicated primary hypercoagulable state, on lifelong anticoagulation condition as unfitting (with contributing category II chronic thromboembolic disease and venous stasis) and the CI was rated at 40% and placed on the Temporary Disability Retired List (TDRL). Exhibit C. Department of...

  • AF | PDBR | CY2014 | PD 2014 02890

    Original file (PD 2014 02890.rtf) Auto-classification: Denied

    SEPARATION DATE: 20070705 Post-Separation)ConditionCodeRatingConditionCodeRatingExam Coagulopathy, Protein C Deficiency, with History of Deep Vein Thrombosis7199-71210%Thrombophlebitis of Popliteal Vein, Left Leg7121NSC*20070223Other x 0 (Not in Scope) Combined: 40%Rated: 0%Derived from VA Rating Decision (VARD)dated 20070802. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2011 | PD2011-00560

    Original file (PD2011-00560.docx) Auto-classification: Denied

    The Board concluded that the evidence of the record did not support rating using the code for pulmonary vascular disease as there were no duty limiting respiratory symptoms and no evidence of chronic or recurrent pulmonary embolism. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows, effective as of...