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AF | PDBR | CY2013 | PD2013 00114
Original file (PD2013 00114.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   CASE: PD1300114
BRANCH OF SERVICE: Army         BOARD DATE: 20130627
SEPARATION DATE: 20050721


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active Reservist CPT/0-3 (74D/CHEMICAL OFFICER) medically separated for a hypercoagulable state manifested by deep vein thrombosis (DVT). The CI presented in 2001 with left leg DVT; was diagnosed with a heritable hypercoagulability disorder, and began anticoagulation therapy. He was deemed non-deployable, and limited to assignments within 100 miles of a continental United States (CONUS) hospital. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded the hypercoagulable condition to the Physical Evaluation Board (PEB) as meeting retention standards IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated hypercoagulable state manifested by two episodes of DVT, with probable pulmonary embolism as unfitting, rated 0%, stating “this condition existed prior to service and was not permanently aggravated by service, but is compensable in accordance with 10 USC 1207a ( 8 year rule) and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB, but withdrew his appeal and was medically separated.


CI CONTENTION: The CI writes: “All symptoms related to the condition were not considered in the final evaluation. I was rated for my platelet count only. The primary reason for my initial diagnosis was edema. I have continued persistent edema in both legs and therefore should have gotten a rating higher than 30%. When I went to Fort Lewis for my MEB prior to actually seeing the board I was informed that 2 of the 3 board members were on Warfarin like me. I was told at that time by my military counsel that the board members could choose not to give me any rating at all and they were unsympathetic to my case. I asked if there were other avenues beyond the MEB, but was told by the same military counsel that the likelihood was the same as the MEB. I returned to Fort Leonard Wood where I began out processing. I went to Personnel and was told that I was not eligible for military retirement due to a less than 30% rating for disability that I received from the MEB. I was informed that this was the case by both active duty and reserve duty personnel during out processing. I was not informed that there was such a thing as the PEBLO or PEB. I was told flatly that I was not eligible for any sort of retirement and that there was no recourse for a reevaluation of my situation. Following my discharge I was given separation pay. I went to my congressman and tried to get my case reviewed through the DOD. The DOD sent the congressman documentation stating that since I had received separation pay that I could not receive medical military retirement and there was nothing they could do. Further reading of the same documentation sent to the congressman states that my case can be reviewed in the case that the service member did not receive due process. I did not receive due process. I was discouraged from addressing the MEB. I was inaccurately informed that I was not eligible for medical retirement. I was not informed that there was recourse with the PEB. I was not even told that the PEB existed, nor was I informed that there was such a thing as a PEBLO. I did not receive due process and deserve a chance to have my disability rating upgraded and given a medical retirement.” The CI also provided these remarks in block 15 of the application: “I have pursued the increase of my initial rating for Leiden Factor V. That rating was not increased. However, I was informed in December 2010 that I was not being rated for any of the symptomatic conditions caused by the Leiden Factor V (deep vein thrombosis, bilateral edema, and pulmonary embolism). I immediately requested a change to my initial 0% rating. I was given a new 60% rating for these symptomatic conditions. I did not receive this new rating until late 2011. I did not know of this board until recently when I simultaneously found out about PEBs, PEBLOs, and this board. Please consider this and waive the three year requirement for review of my records. At no point in my out processing have I been given adequate information to make an informed decision. When I tried to pursue changes to my disability rating I was misinformed as to my rights in regard to recourse.”


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 hypercoagulable state 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 (BCMR).


 RATING COMPARISON :

Service IPEB – Dated 20050426
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
HYPERCOAGULABLE STATE 7199-7121 0% LLE DVT ASSOCIATED W/LEIDEN FACTOR V 7121 10% 20050919
LEIDEN FACTOR V 7799-7705 0% 20050919
No Additional MEB/PEB Entries
 Other x 7 20050919
Combined: 0%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 60321 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: 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. The Board also acknowledges the CI’s assertions that his disability disposition was unfair in that the CI contends he did not know about the PEB or a Physical Evaluation Board Liaison Officer. It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations; and, redress in excess of the Board’s scope of recommendations (as noted above) must be addressed by the BCMR and/or the United States judiciary system.

Hypercoagulable Condition. The CI reported a history of a DVT and possible pulmonary embolus in 1997 which was treated at a civilian hospital. The pulmonary embolism was reportedly confirmed by chest X-ray in 1999. In July 2001, the CI complained of 1-2 weeks of pain and swelling of the left lower leg, which he described as similar to the blood clot he had in 1997. There was visible swelling from the ankle to the knee. An ultrasound exam revealed a DVT extending from the popliteal fossa (behind the knee) to the mid-thigh. He was hospitalized overnight and began anticoagulant therapy. Laboratory testing indicated he was positive for heterozygous factor V Leiden (inherited). He began Warfarin therapy (an oral anticoagulant) in August 2001; telephone notes indicated intermittent non-compliance with anti-coagulant monitoring of international normalized ratio (INR) and Warfarin dose adjustments for sub- or supra-therapeutic INRs. He presented to an emergency room in late August 2001 complaining of cramping in the left calf. Examination showed calf tenderness, but no suggestion of a venous blood clot. An ultrasound showed no evidence of DVT above the left knee. In November 2002, he complained of bilateral lower extremity pain following a road march; the exam found tenderness and no discoloration, but mild edema bilaterally. The assessment was shin splints. A case management note in March 2005 noted no current symptoms or difficulty performing his job. The narrative summary (NARSUM) 4 months prior to separation noted that the CI was “totally asymptomatic.” His Warfarin dose was 3 mg or 4 mg on alternating days. There was no mention of the need for compression stocking use. The physical examination was normal; no varicose veins were noted. Lab testing indicated a normal complete blood count and the INR was 3.37 (target range 2-3). A chest X-ray was normal. The commander’s statement cited the supervisor’s assessment of exceptional performance; the only duty limitation was the requirement to be assigned near a CONUS hospital. The assignment officer indicated options which would have allowed the CI to continue on active duty in a non-deployable status. At the VA Compensation and Pension (C&P) exam in September 2005 (2 months after separation) the examiner noted leg pain after prolonged standing and walking, intermittent leg edema relieved by foot elevation or compression hosiery, and shortness of breath (SOB) with exertion, related to DVT. There was no light-headedness, headaches, easy fatigability, weakness, easy bleeding, frequent infections, or SOB due to the factor V Leiden. He was able to drive a car, push a lawn mower, work in the garden, climb stairs, and perform activities of daily living. He was not employed. The examiner opined that the only functional impairment was related to the potential to bleed more easily due to Warfarin therapy. The cardiovascular, lung, and lower extremities exams were normal; there was no hemorrhage or bruising of the skin and no varicose veins. A complete blood count, chest X-ray, and pulmonary function test were all normal.

The Board directs attention to its rating recommendation based on the above evidence. Under an analogous 7121 code (post-phlebitic syndrome of any etiology), the PEB assigned a 0% rating “asymptomatic palpable or visible varicose veins.” The condition was designated as existing prior to service by the PEB, but no deduction was applied. The VA’s 10% rating was based on the same code for “intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery.” The VA also assigned a non-compensable evaluation for a marginally diminished platelet count using an analogous 7705 code. The service treatment record documented no thrombosis problems following the start of anticoagulant therapy in July 2001 through the MEB exam; and the MEB and C&P examiners reported no objective findings related to abnormal clotting or bleeding, or of any daily functional impairment. The Board debated the VA examiner’s report of mild edema in contrast to the NARSUM examiner’s report of no symptoms and normal physical findings, and concluded that the evidence just described was best depicted by the 0% rating criteria. Board members also agreed that there was no evidence supporting a compensable rating under the 6817 code (pulmonary vascular disease) or 7705 code (thrombocytopenia, primary, idiopathic or immune). 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 hypercoagulable state 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 hypercoagulable state 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Hypercoagulable State 7199-7121 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130314, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130018157 (PD201300114)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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