RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20090527 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200061 
BOARD DATE:  20121030 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  active  duty  SPC/E-4  (35F10/Intelligence  Analyst),  medically 
separated for hypercoagulable state due to May Thurner Syndrome referred to as recurrent left 
lower extremity deep vein thrombosis (DVT).  In March 2007, the CI was diagnosed with a left 
lower  extremity  DVT  and  a  left-sided  pulmonary  embolus  (PE).    She  was  treated  with 
anticoagulation  medication.    She  was  transferred  to  Brooke  Army  Medical  Center  and 
underwent an embolectomy and stent placement in her left iliac vein.  She was also diagnosed 
with  May  Thurner  Syndrome  and  remained  on  Coumadin  and  did  well.    She  remained 
asymptomatic and in October 2007 she was doing well enough to discontinue the Coumadin. 
She continued to do well until March 2008 when she experienced a repeat DVT in the left lower 
extremity and a second PE, this time on the right side after a long car ride.  Anticoagulation 
medication  was  restarted.    She  also  underwent  repeat  embolectomy  with  intraoperative 
Greenfield  filter.    After  this  second  DVT  and  PE,  lifelong  Coumadin  anticoagulation  was 
recommended.  Hypercoagulable state due to May Thurner Syndrome referred to as recurrent 
left lower extremity DVT condition could not be adequately rehabilitated and the CI was unable 
to  meet  the  physical  requirements  of  her  Military  Occupational  Specialty  (MOS)  or  satisfy 
physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical 
Evaluation  Board  (MEB).    The  chronic  left  pleurisy  condition,  identified  in  the  rating  chart 
below, was identified and forwarded by the MEB as medically unacceptable IAW AR 40-501.  
The  mild  anemia  and  abnormal  pap  conditions,  identified  in  the  rating  chart  below,  were 
identified and forwarded by the MEB as medically acceptable.  The Physical Evaluation Board 
(PEB)  adjudicated  the  hypercoagulable  state  due  to  May  Thurner  Syndrome  referred  to  as 
recurrent  left  lower  extremity  DVT  condition  as  unfitting,  rated  10%  with  application  of  the 
Veteran’s Affairs Schedule for Rating Disabilities (VASRD) and the US Army Physical Disability 
Agency (USAPDA) Table of Analogous Codes of 25 November 2008.  The PEB noted that while 
the  May  Thurner  Syndrome  was  congenital  and  exited  prior  to  service  (EPTS),  the  unfitting 
condition was permanently aggravated and was therefore assigned a disability rating.  No rating 
deduction was made.  The remaining conditions were determined to be either not disqualifying 
(chronic left pleurisy) or not unfitting (mild anemia and abnormal Pap) and were not rated.  The 
CI made no appeals, and was medically separated with a 10% disability rating. 
 
 
CI CONTENTION:  “Deep Vein Thrombosis”  “Chronic Left Pleurisy”  “May Thurner Syndrome” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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.  The hypercoagulable state due to May Thurner Syndrome referred to as recurrent left 
lower extremity deep vein thrombosis (DVT) and chronic left pleurisy conditions as requested 
for  consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  is 
addressed  below,  in  addition  to  a  review  of  the  ratings  for  the  unfitting  conditions.    Note: 
Chronic left pleurisy was determined to be “not disqualifying” by the PEB.  The other requested 

Hypercoagulable State due to May 
Thurner Syndrome referred to as 
Recurrent Left Lower Extremity Deep 
Vein Thrombosis (DVT) 
Chronic Left Pleurisy 
Mild Anemia 
Abnormal PAP 

7799-7704 

10% 

Not Disqualifying 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

VA (~1 Month After Separation) – All Effective Date 

20090528 
Code 

Rating 

Exam 

Deep Vein Thrombosis 
with May-Thurner, Left 
Lower Extremity 
Pulmonary Embolism 
with Pleurisy  

7120 

20% 

20090619 

6899-
6817 

60% 

20090619 

NO VA ENTRY 

Deep Vein Thrombosis, 
Right Lower Extremity 

7120 

40% 

0% x 1/Not Service Connected x 1 
Combined:  80% 

20090619 
20090619 

conditions [mild anemia, and abnormal PAP] are not within the Board’s purview.  The remaining 
conditions  rated  by  the  VA  at  separation  and  listed  on  the  DD  Form  294  are  not  within  the 
Board’s purview.  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 
Service Board for the Correction of Military Records.   
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20081215 

Condition 

Code 

Rating 

Condition 

Combined:  10% 

 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation.  The Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 
which  the  Disability  Evaluation  System  (DES)  operates.    While  the  DES  considers  all  of  the 
member's medical conditions, compensation can only be offered for those medical conditions 
that cut short a member’s career, and then only to the degree of severity present at the time of 
final  disposition.    However  the  Department  of  Veterans’  Affairs  (DVA),  operating  under  a 
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting 
the  Veteran’s  disability  rating  should  the  degree  of  impairment  vary  over  time.    The  Board 
utilizes  DVA  evidence  proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI 
6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The 
Board’s authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES 
fitness determinations and rating decisions for disability at the time of separation and is limited 
to  conditions  adjudicated  by  the  PEB  as  either  unfitting  or  not  unfitting.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. 
 
Hypercoagulable  State  due  to  May  Thurner  Syndrome  referred  to  as  Recurrent  Left  Lower 
Extremity  Deep  Vein  Thrombosis  (DVT)  Condition.    The  CI  first  experienced  a  left  lower 
extremity deep venous thrombosis (DVT) with a left-sided pulmonary embolism (PE) in March 
2007.    She  was  seen  multiple  times  before  the  diagnosis  became  clear  and  was  eventually 
treated at Brook Army Medical Center.  The diagnosis of May Thurner Syndrome, a congenital 
constriction of the left common iliac vein, was made during this hospitalization.  May Thurner 
Syndrome is associated with leg swelling and pain, blood clots, and deep vein thrombosis due 
to  mechanical  compression  of  the  left  common  iliac  vein  and  does  not  result  in  a 
hypercoagulable state.  The CI underwent embolectomy and a stent was placed in her left iliac 
vein. 
  She  was  anticoagulated  sequentially  with  heparin,  Lovenox,  and  Coumadin.  

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Anticoagulation with Coumadin was continued for 6 months and then discontinued in October 
2007.  She remained symptom free until March 2008 when she had recurrence of a left lower 
extremity  DVT  and  PE,  this  time  right-sided.    This  occurred  after  the  return  trip  of  an 
approximately  18  hour  long  car  ride  despite  frequent  stops.    She  was  again  anticoagulated 
serially  with  heparin,  Lovenox,  and  Coumadin  and  underwent  embolectomy  at  Brooke  Army 
Medical  Center.    A  Greenfield  filter  was  placed  prior  to  the  embolectomy  and  was  then 
removed.    At  this  time  lifelong  anticoagulation  with  Coumadin  was  recommended  based  on 
recurrent DVTs and recurrent PEs and she was then referred for an MEB. 
 
The narrative summary (NARSUM) completed 7 month prior to separation noted a normal gait.  
The  lower  extremity  exam  was  normal  without  tenderness  to  palpation,  edema,  or  palpable 
masses or cords.  However, the MEB examination completed 2 months prior noted mild, non-
pitting edema of the left lower extremity and 4 to 5 coin sized bruises on both legs in various 
stages  of  healing.    Her  prothrombin  time  and  international  normalized  ratio  (INR)  were 
therapeutic  on  Coumadin.    Lung  scans  documented  persistent  profusion  defect  and  this  is 
discussed in more detail below.  The examiner noted that hypercoagulability had EPTS and was 
not  aggravated  by  Army  duties.    Although  the  CI  was  issued  a  permanent  P3  profile  with 
significant and multiple restrictions signed by this examiner along with another physician, the 
examiner stated the CI was “otherwise fit and has no duty limiting PHYSICAL limitations.” 
 
A VA Compensation and Pension (C&P) was performed on 19 June 2009, approximately 3 weeks 
after  the  CI  separated  from  the  Army.    This  examination  notes  the  CI  had  recently  been 
hospitalized at Wilford Hall Air Force hospital from 12 June 2009 to 18 June 2009 with DVTs in 
both the left and right lower extremities.  A Greenfield filter was placed during this admission 
and the CI was taking subcutaneous Lovenox at the time of the C&P examination.  The actual 
records from Wilford Hall are not available for review.  The C&P examination reports a venous 
Doppler ultrasound performed on 2 June 2009 (6 days after separation) documented a deep 
vein  thrombosis  of  the  left  lower  extremity  within  the  common  femoral  vein,  superficial 
femoral vein, and partial thrombosis of the popliteal vein.  Another ultrasound performed on 
10 June 2009 documented venous thrombosis of the right lower extremity from the common 
femoral vein through the popliteal vein.  The CI was using compression stockings.  The physical 
examination of the left lower extremity noted “no heat, redness, swelling, or edema.  No skin 
ulceration, breakdown, eczematous lesions, and pigmentation and chronic skin changes from 
her venous insufficiency noted.”  The CI had an antalgic gait that was attributed to the pain in 
her right lower extremity.  The right lower extremity had 2+ pitting edema involving 3/4 of the 
leg and mild tenderness, but no heat or redness.  An antithrombin III or Factor III deficiency 
with  resultant  hypercoagulability  was  diagnosed  either  during  the  June  2009  admission  or 
during a hospitalization for a thrombotic stroke that occurred in October 2009 when the CI was 
32 weeks pregnant.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  determined  that  while  May  Thurner  Syndrome  is  a  congenital  condition  and  therefore 
EPTS,  it  was  considered  to  be  permanently  aggravated  by  service  and a  disability  rating  was 
applied without any deduction.  The VA made no specific mention of any condition EPTS and 
made no rating deductions.  The PEB rated the condition analogous to the hematologic system 
condition of 7704 polycythemia vera.  This condition is caused by the presence of an excessive 
amount of red blood cells and could be used to analogously rate a hypercoagulable condition.  
However,  May  Thurner syndrome  is  a mechanical  compression of the  left  common  iliac  vein 
which  can  lead  to  left  leg  pain  and  swelling  and  deep  vein  thrombosis.    No  generalized 
hypercoagulability  was  diagnosed  in  this  patient  prior  to  separation  and  she  had  no 
hematologic abnormalities other than those linked to her medication.  Her condition was due 
to the mechanical compression of the left common iliac vein with resultant DVTs in the left leg 
and  pulmonary  emboli.    Therefore,  the  PEB  nomenclature  of  “hypercoagulable  state  due  to 
May Thurner Syndrome” is not clinically accurate and the analogous use of a hematologic code 

   3                                                           PD1200061 
 

is not appropriate.  With the pathophysiology related to a venous disorder, the CI’s condition is 
more appropriately rated as analogous to 7120 varicose veins.  She was at risk for future DVTs 
and PEs due to the mechanical compression of the vein, not a hematologic abnormality.  The VA 
rated the recurrent left lower extremity DVTs as 7120 and applied a 20% rating for a history of 
edema of the extremity with some changes of coloration to the extremity.   While the CI did 
have intermittent edema with pain and fatigue in the left lower extremity, she had no swelling 
at  either  the  NARSUM  or  the  C&P  examinations;  therefore  the  20%  rating  which  requires 
persistent edema, incompletely relieved by elevation of the extremity, is not warranted.  She 
had been wearing compression stockings and one can assume this helped relieve her swelling.  
Therefore a 10% disability rating is warranted under code 7199-7120.  After due deliberation, 
considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board 
recommends  a  disability  rating  of  10%  for  the  hypercoagulable  state  due  to  May  Thurner 
Syndrome referred to as recurrent left lower extremity DVT condition, rated as 7199-7120.   
 
Contended PEB Conditions.  The contended condition adjudicated as not unfitting by the PEB 
was chronic left pleurisy condition.  The Board’s first charge with respect to these conditions is 
an assessment of the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold 
for  countering  fitness  determinations  is  higher  than  the  VASRD  §4.3  (reasonable  doubt) 
standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair 
and equitable” standard.   
 
The  CI’s  permanent  profile  was  for  DVT  and  PE,  recurrent  and  included  many  restrictions  of 
aerobic  and  cardiovascular  activities  that  can  only  be  attributed  to  the  recurrent  PEs  and 
resultant chronic left pleurisy condition.  While the CI was allowed to walk, bike and swim only 
at her own pace and distance, she was prohibited from running more than one quarter mile.  
She was also not able to carry and fire her assigned weapon, move with a fighting load of 48 
pounds for 2 miles, construct an individual fighting position, or do 3 to 5 second rushes under 
direct and indirect fire.  The recurrent DVTs and PEs as well as the May Thurner syndrome with 
its increased risk for future DVT and PE together prevented her from deploying.  This inability to 
deploy is the only restriction that can be attributed to the May Thurner Syndrome.  However, 
this restriction would also be in place if she only had the chronic left pleurisy condition and the 
risk of recurrent DVT and PE was not present.  The commander’s letter states she was able to 
perform the assigned duties for her grade and MOS and that she was performing these duties.  
It also states the CI’s medical condition and profile limitations did not affect the unit’s ability to 
accomplish  its  mission  and  that  she  was  able  to  work  without  an unreasonable number  and 
duration of rest periods.  However, the commander’s letter was completed in October 2008, 
prior  to  the  date  of  the  permanent  profile.    The  CI’s  MOS  of  Intelligence  Analyst  is  not  a 
physically demanding job and the physical restrictions imposed would not preclude her from 
performing the duties of this MOS.  However, the physical restrictions would preclude her from 
performing the basic tasks required of all soldiers as described above. 
 
Although the MEB NARSUM examiner stated in October 2008 (approximately 7 months prior to 
separation) that this condition was not disqualifying and could be managed, he also noted a 
permanent perfusion defect in both  lungs noted on multiple ventilation perfusion scans that 
would probably be present for life.   The examiner went on to say that the CI was otherwise 
physically fit and had no duty limiting physical limitations.  However, the permanent P3 profile 
signed by that same examiner and a more senior physician in December 2008 documented the 
physical limitations noted above.  Additionally, the MEB forwarded this condition in November 
2008 as medically unacceptable IAW AR 40-501.  The MEB Proceedings recorded on DA Form 
3947 was signed by this examiner and a separate more senior physician.  It appears that the 
two  separate  and  more  senior  physicians  noted  that  the  examiner  was  mistaken  in  his 
assessment  that  the  CI  had  no  physical  limitations  and  that  the  examiner  had  changed  his 
opinion as well.  The PEB did not formally adjudicate this condition as unfitting or not unfitting 
but  merely  quoted  the  NARSUM  and  stated  that  this  condition  was  “in  and  of  itself  not 

   4                                                           PD1200061 
 

disqualifying.”  No rating was applied and while it can be assumed that the PEB did not find this 
condition  to  be  separately  unfitting,  the  DA  Form  199  is  silent  on  the  matter.    The  PEB  did 
specifically state the other two conditions forwarded by the MEB as medically acceptable were 
not unfitting. 
 
The chronic left pleurisy condition did not meet physical retention standards of AR 40-501 and 
the inability to perform the basic soldier tasks as delineated on the permanent P3 profile and 
described  above  made  the  soldier  unfit  for  continued  service.    As  all  of  these  physical 
limitations (except the specific ability to deploy) result from the chronic left pleurisy condition 
alone,  this  condition  is  considered  unfitting.    After  due  deliberation  in  consideration  of  the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  sufficient  cause  to 
recommend a change in the PEB fitness determination for chronic left pleurisy condition.   
 
The C&P examination performed in June 2009, less than a month after separation from service, 
documented the CI had shortness of breath with any type of exertional activity, including brisk 
or prolonged walking.  She was only able to walk 100 yards without becoming short of breath.  
She  also  had  intermittent,  sharp  left  lower  chest  area  pain  that  occurred  and  resolved 
spontaneously almost every day.  She had a normal oxygen saturation level at rest and was not 
prescribed  oxygen  therapy.    However,  she  used  a  manual  wheelchair  to  get  around  in  her 
home.  Pulmonary function testing (PFT) was completed prior to separation in March 2009 and 
was normal.  This demonstrates the dyspnea on exertion is related to the recurrent PEs, not to 
asthma or any other respiratory disease.  
 
As there is no diagnostic code for this condition, the VA rated this condition analogous to 6817 
pulmonary  vascular  disease. 
for  chronic  pulmonary 
thromboembolism  requiring  anticoagulant  therapy.    The  CI  required  life-long  anticoagulant 
therapy to prevent both recurrent PEs and DVTs.  After due deliberation, considering all of the 
evidence  and mindful  of  VASRD  §4.3  (reasonable  doubt), the  Board  recommends  a  disability 
rating of 60% for the chronic left pleurisy and dyspnea due to recurrent pulmonary embolism.   
 
 
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.  This includes the use of 
the US Army Physical Disability Agency (USAPDA) Table of Analogous Codes of 25 November 
2008.    In  the  matter  of  the  May  Thurner  Syndrome  with  recurrent  left  lower  extremity  DVT 
condition,  the  Board  unanimously  recommends  a  disability  rating  of  10%,  coded  7199-7120 
IAW VASRD §4.104.  In the matter of the contended chronic left pleurisy condition, the Board 
unanimously agrees that it was unfitting; and, unanimously recommends a disability rating of 
60%, coded 6899-6817 IAW VASRD §4.100.  There were no other conditions within the Board’s 
scope of review for consideration.   
 
 

  They  applied  a  60%  rating 

   5                                                           PD1200061 
 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of her prior medical separation:   
 

UNFITTING CONDITION 

May Thurner Syndrome with Recurrent Left Lower Extremity Deep 
Vein Thrombosis (DVT) 
Chronic Left Pleurisy and Dyspnea due to Recurrent Pulmonary 
Embolism 

VASRD CODE  RATING 
7199-7120 

10% 

6899-6817 
COMBINED 

60% 
60% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120113, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   6                                                           PD1200061 
 

 
 

 
 
 

 
 

a.  Providing a correction to the individual’s separation document showing that the 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXXX, AR20120020634 (PD201200061) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 60% 
effective the date of the individual’s original medical separation for disability with severance 
pay.   
 
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: 
 
 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with severance pay. 
 
 
effective the date of the original medical separation for disability with severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 60`% 
effective the date of the original medical separation for disability with severance pay. 
 
 
medical TRICARE retiree options. 
 
 
 
 
 
 
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 
 
 

b.  Providing orders showing that the individual was retired with permanent disability 

     XXXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   7                                                           PD1200061 
 

 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

   8                                                           PD1200061