RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20030604 

 
NAME:    
CASE NUMBER:  PD1200669 
BOARD DATE:  20121120 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E4 (92A/Automated Logistics Supply Specialist), 
medically  separated  for  Raynaud’s  disease  and  asthma.    The  CI  first  experienced  Raynaud’s 
disease, exclusively during cold exposure, in January 2000 and after complete evaluation failed 
to  reveal  an  underlying  cause,  preventive  measures  instituted.    She  also  began  experiencing 
asthma  symptoms  in  mid-2000  and  after  complete  evaluation  confirmed  the  diagnosis  of 
asthma, medical treatment was instituted.  The Raynaud’s disease and asthma conditions did 
not  improve  adequately  with  treatment  to  meet  the  physical  requirements  of  her  Military 
Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent 
P3/L2 profile and referred for a Medical Evaluation Board (MEB).  In addition to the Raynaud’s 
disease and asthma conditions, the MEB identified the left knee pain, bilateral plantar fasciitis, 
lumbar and thoracic back pain and acne vulgaris conditions (annotated in the rating comparison 
chart below) and forwarded all conditions for Physical Evaluation Board (PEB) adjudication.  The 
PEB adjudicated the Raynaud’s disease and asthma conditions as unfitting and rated each 0% 
with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The left knee 
pain, bilateral plantar fasciitis, lumbar and thoracic back pain conditions were each identified as 
“not  disqualifying”  while  the  acne  vulgaris  condition  was  designated  “not  unfitting.”    The  CI 
made no appeals, and was medically separated with a 0% disability rating. 
 
 
CI  CONTENTION:    “Raynaud's  Disease-MEB  board  rated  me  at  0%;  however,  the  VA  recently 
found me to be rated at 10% for this condition. I regularly see a civilian non-VA Rheumatologist 
for treatment of my Raynaud's condition. My Rheumatologist’s name I regularly see is Dr ---- at 
the Center for Arthritis in Chesapeake, VA.  Asthma-MEB board rated me at 0%; however, the 
VA found me to be rated 30% for this condition. I take a number of medications regularly to 
treat my asthma condition and keep it under control. I see my civilian Primary Care Provider for 
treatment of my asthma and her name is Dr --- at the Family Physicians of Chesapeake.” 
 
 
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.    The  conditions  Raynaud’s  disease  and 
asthma as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board 
purview  and  are  addressed  below.    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 the Correction of Military Records 
 
 
 
 
 
 
 

RATING COMPARISON: 
 

Service  PEB – Dated 20030303 

VA (3 Mos. Post-Separation) – All Effective Date 20030605 

Condition 
Raynaud’s disease 
Asthma 
Left Knee Pain, s/p 
Surgery for Meniscal Tear 
Bilateral Plantar Fasciitis 

Lumbar & Thoracic Back 
Pain 
Acne Vulgaris 

Code 

Rating 

7117-6602 

0% 
0% 
6602 
Not disqualifying 

Not disqualifying 

Not disqualifying 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  0% 

Condition 

Raynaud’s Phenomenon 
Asthma 
Postoperative Residuals of 
Injury, Left Knee 
Morton’s Neuroma and Plantar 
Fasciitis Right Foot 
Chronic Lumbar Strain w/Mild 
Dextroscoliosis 
Chronic Thoracic Strain 
Chronic Acne 
Left Chronic Achilles Tendonitis 
Chronic Right Ankle Sprain 

Code 
7117 
6602 
5260 

5279 

5295 
5291 
7819 

5099-5024 

5271 

Rating 
0%* 
30% 
0% 

10% 

10% 
0% 
0% 
10% 
10% 

Exam 

20030319 
20030319 
20030319 

20030319 

20030319 
20030319 
20030319 
20030319 
20030319 

 

0% X 6 others/ Not Service-Connected x 3 

Combined:  60% (Bilateral Factor 2.7%) 

*7117: increased to 100% effective 20031211 then decreased to 10% effective 20040201  
 
 
ANALYSIS  SUMMARY:    The  Board  notes  the  current  VA  ratings  listed  by  the  CI  for  all  of  her 
service-connected conditions, but must emphasize that its recommendations are premised on 
severity at the time of separation.  The VA ratings which it considers in that regard are those 
rendered most proximate to separation.  The Disability Evaluation System (DES) 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). 
 
 
Raynaud’s  Disease  Condition.    At  the  MEB  exam  prepared  approximately  9  months  prior  to 
separation, the CI documented nothing specific concerning the Raynaud’s disease.  The MEB 
physical exam noted the reason for the MEB was Raynaud’s phenomenon.  It also contained the 
statement, “A cold weather injury involving the CI’s hands in 1999.”  The narrative summary 
(NARSUM)  prepared  approximately  4  months  prior  to  separation  noted  the  beginning  of  her 
Raynaud’s symptoms in January 2000 after suffering a cold weather injury to her hands.  After 
that  initial  injury,  the  CI  experienced  symptoms  of  cyanotic  and  numb  hands,  feet,  ears  and 
nose with any cold exposure, then significant pain when the circulation returned to those areas.  
The  CI  also  noted  some  blistering  of  her  feet  after  training  along  with  minimal  peeling  and 
sloughing  on  her  hands.    All  reasonable  preventative  measures  were  attempted  but  did  not 
sufficiently  prevent  the  attacks  from  negatively  impacting  her  duty  performance.    She  was 
evaluated by a Rheumatologist who confirmed the history and performed capillaroscopy that 
was remarkable for capillary loop dilation with no drop out.  The final assessment was a history 
compatible  with  Raynaud’s  phenomenon  with  recent  unremarkable  serologic  and  laboratory 
evaluations  and  no  overt  clinical  physical  findings  to  suggest  an  underling  connective  tissue 
disease.  Physical exam revealed skin notable for only mild acne lesions.  Cardiovascular exam 
was  normal.    The  commander’s  letter  includes  the  statement  that  the  CI  was  “…limited  to 
working inside during the winter due to her permanent profile when the temperature is below 
fifty degrees.” 
 
At the VA Compensation and Pension (C&P) exam performed approximately 3 months prior to 
separation, the CI reported a similar history to that given above with the following additional 
comments: suffering “1% frostbite” on her fingers while deployed in November 1999, advised 
by the Rheumatologist not to remain in an area where the temperature is less than 50 degrees 
Fahrenheit.  She denied any changes of her fingernails and toenails, and also denied any loss of 
tissue at the extremities.  When she was not suffering from Raynaud’s phenomenon she denied 
any difficulty in the hands and feet except for numbness when carrying objects.  Physical exam 

   2                                                           PD1200669 
 

revealed the following: the fingers and toes were cold to touch.  The Allen test was positive 
bilaterally at the hands; the peripheral pulses of the upper and lower extremities were palpable 
(2+ bilaterally).  There was no erythromelalgia at the extremities.  When the hands and feet 
were placed in cold running tap water, the fingers and toes turn white after 2 minutes, and blue 
after 5 minutes.  The color of the toes and fingers returned to normal after about an hour.  In 
addition to the above, the Rheumatology consult prepared in approximately 11 months prior to 
separation provided historical information useful for rating purposes.  It documented that the 
episodes of Raynaud’s phenomenon occur almost exclusively with cold weather exposure.  “The 
patient had these episodes occur almost on a daily basis especially early in the morning.”  No 
skin necrosis.  The Rheumatologist recommended cold exposure avoidance measures and the CI 
was offered a trial of Nifedipine which she declined but would consider should her symptoms 
become more prominent. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB applied the analogous code 7117-6602 for the Raynaud’s disease citing “description more 
consistent with Raynaud’s phenomenon, only symptomatic if exposed to cold for more than 5 
minutes,” and rated at 0% due to “does not meet minimal rating criteria and symptoms only 
occur if exposed to cold as noted.”  The VA applied code 7117, Raynaud’s syndrome, and rated 
it 0% citing normal appearance of with no tissue loss of the bilateral hands and feet.  This rating 
was subsequently increased to 100% after the CI had a surgical procedure to her foot, resection 
of  the  right  second  metatarsal  head  due  to  avascular  necrosis,  then  was  decreased  to  10% 
(based on characteristic attacks occurring  one to three times a week) after her convalescent 
period.  The rating criteria for Raynaud’s syndrome include tissue damage (auto-amputation or 
ulcers) and the frequency of characteristic attacks.  There were no auto-amputation or ulcers 
noted in this case and therefore the 100% and 60% criteria were not met.  The 40% evaluation 
requires the characteristic attacks to occur at least daily, again not consistently present in this 
case.  The 20% rating requires the attacks to occur four to six times per week while the 10% 
rating calls for one to three attacks per week.  This case documents attacks occurring almost 
exclusively  during  cold  exposure  which  during  some  times  of  the  year  was  daily  while  other 
times of the year less frequently.  A potential method of determining the frequency of attacks is 
to estimate the number of attacks that occur over a year timeframe and divide that figure by 
the number of weeks in a year.  During the cold season, it was documented that the CI could 
experience characteristic attacks daily, while in the warmer times of the year not experience 
these attacks at all.  Assuming a cold season of 3 months, that is 90 attacks a year divided by 52 
weeks a year yields an estimate of 1.7 attacks a week, which meets the 10% rating threshold.  
The  Board  deliberations  centered  on  which  frequency  of  attacks  best  fit  the  pattern 
documented in the records.  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 
Raynaud’s disease condition. 
 
Asthma Condition.  There are three pulmonary function tests (PFTs)  evaluations in evidence, 
with  documentation  of additional  ratable  criteria,  which  the  Board  weighed  in  arriving  at  its 
rating recommendation; as summarized in the chart below. 
 
 
 
 
 
 
 
 
 
 
 

   3                                                           PD1200669 
 

Pulmonary Function Tests 

PFT results ~8 Mo. Pre-Sep 
Post-bronchodilator values 

Used in NARSUM 

FEV1 (% Predicted) 

FEV1/FVC 

77% 
90% 

VA C&P~3 Mo. Pre-Sep 
Pre-bronchodilator values 

only* 
67% 
89% 

~3 Mo. Pre-Sep 

Post-bronchodilator values 

78% 
106% 

Meds 

Albuterol as needed 

Advair & Singulair discussed 

Lungs were clear  
+ 8% bronchodilator 

response 

Albuterol 30min prior to 

exercise 

No Advair use documented 

Singulair used 

Normal lung exam 

Albuterol as needed 

No Advair use documented 

Lung exam was normal 

§4.97 Rating 

10% 

30% 

10% 

* §4.96 (d) 4 states post-bronchodilator PFT studies required for disability evaluation 
 
At  the  MEB  exam  prepared  approximately  9  months  prior  to  separation,  the  CI  reported 
“Asthma-Had an attack and was put on an inhaler in Korea.”  The MEB physical exam noted 
“lungs  clear  to  auscultation  all  fields.”    A  specialty  care  consult  prepared  8  months  prior  to 
separation contained the following additional information not contained in the NARSUM:  The 
CI experienced no problems with breathing as a child, actually ran track in high school without 
problems  and  completed  all  military  training  without  problems.    Lungs  were  clear  to 
auscultation.    PFT  results  are  noted  in  the  chart  above  and  were  used  in  preparation  of  the 
NARSUM.    The  NARSUM  notes  the  CI’s  asthma  symptoms  began  while  she  was  stationed  in 
Korea and began to fall out of run formations.  She was sent to remedial physical training twice 
daily and experienced increased shortness of breath and chest tightness and had an episode of 
syncope while running.  She was evaluated at the troop medical clinic and given an inhaler.  Her 
symptoms continued and she was referred to the pulmonary clinic at her new post.  When her 
PFTs  and  Methacholine  challenge  tests  were  positive  and  consistent  with  asthma,  she  was 
started on “maximal medical therapy” (Singulair, Advair and Albuterol) and had no attacks on 
those medications.  The CI experienced wheezing with upper respiratory infections.  PFTs and 
pertinent physical exam findings are summarized in the chart above. 
 
At  the  VA  Compensation  and  Pension  (C&P)  exam  performed  almost  3  months  prior  to 
separation, the CI reported developing cold and exercise induced asthma in 2000.  She stated 
she was given albuterol and Singulair to use and used her albuterol inhaler 30 minutes prior to 
exercise.    She developed  shortness  of  breath  at  night  and  needed  to  sleep upright.    Current 
medications were Albuterol and Singulair (dosage and frequency not given).  PFT results and 
pertinent physical exam finding are summarized in the chart above. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  utilized  VASRD  code  6602;  asthma,  bronchial,  and  rated  it  0%  specifically  based  on 
“intermittent use of medications with last set of prescriptions in Nov. ‘02.”  The CI did have a 
verified history of asthmatic attacks and was using her inhaler medications intermittently.  The 
VA applied the same 6602 code but rated her asthma at 30% based on her PFT results noted on 
the C&P examination.  The ratings for code 6602 are based on post-bronchodilator PFT results, 
frequency of medication use and exacerbations/physician visits for disease management.  It is 
clear in the records present for review that the CI did not require bronchodilator medications 
on a daily basis, monthly provider visits for disease management or any courses of oral steroids.  
She  was  using  an  oral  medication,  Singulair,  at  unknown  frequency  and  intermittently  used 
inhaled  bronchodilator  medication.    In  asthma,  Singulair-mediated  effects  include  airway 
edema,  smooth  muscle  contraction,  and  altered  cellular  activity  associated  with  the 
inflammatory  process.    These  effects  are  broad  in  scope  and  do  not  exclusively  act  as  a 
bronchodilator  or  anti-inflammatory  medication.    The  PFT  results  present  in  the  record 
proximate to separation provide additional data for rating purposes.  The VASRD §4.96 states 
that  post-bronchodilator  values  are  to  be  used  for  rating  purposes  and  the  PFT  values 

   4                                                           PD1200669 
 

contained in the C&P exam are pre-bronchodilator values.  The two other PFT results present, 
both within 12-months of separation, are post-bronchodilator values one of which was used by 
the PEB for adjudication.  Both of these PFT results document values that meet the threshold 
for the 10% VASRD rating, along with the intermittent use of inhaled bronchodilator therapy.  
The next higher, 30%, rating requires daily bronchodilator medications, any use of inhalational 
anti-inflammatory medications or post-bronchodilator PFT values worse than those present in 
this case.  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 asthma 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  Raynaud’s  disease  condition,  the  Board  unanimously 
recommends a disability rating of 10%, coded 7117 IAW VASRD §4.104.  In the matter of the 
asthma condition, the Board unanimously recommends a disability rating of 10%, coded 6602 
IAW  VASRD  §4.97.    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 

7117 
6602 

COMBINED 

10% 
10%  
20% 

Raynaud’s Disease  
Asthma 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120603, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   5                                                           PD1200669 
 

 
 

 
 

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  
 
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 
 
 
 

      
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 

 
 
 

 
 
 

 
 
 

 
 
 

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