RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01314
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Military Intelligence Systems Maintainer/Integrator, medically separated for “chronic right lower extremity pain due to complex regional pain syndrome,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends she was misdiagnosed and treated for over 10 years for a condition she did not have (conservatively and with medication).  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080402	VARD - 20081006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Lower Extremity Pain due to Complex Regional Pain Syndrome	8799-8722	10%	Reflex Sympathetic Dystrophy, S/P Navicular Accessory Excision and DJD Right Great Toe	5284	10%	20080612	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Lower Extremity Pain due to Complex Regional Pain Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right foot surgery in September 1998 for pain limiting physical activity.  After the surgery the CI reported right foot pain and hypersensitivity at the inner ankle that radiated up the right leg.  In November 1998 the CI was diagnosed with reflex sympathetic dystrophy (a clinical syndrome characterized by pain, swelling, and vasomotor dysfunction of an extremity).  Despite treatment, the right lower extremity reflex sympathetic dystrophy could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded right foot reflex sympathetic dystrophy pain for PEB adjudication.  A podiatry note dated 7 September 2005 noted chronic right heel pain radiating up the right lower extremity.  The physical examination showed tingling in the right heel with palpation of the medial calcaneal nerve, positive nerve entrapment testing (positive Tinel’s sign) bilaterally, and an abnormal gait.  Diagnoses of medical calcaneal nerve neuritis and tarsal tunnel syndrome were rendered.  At the NARSUM examination, the CI reported daily, constant 4/10 foot pain.  The pain worsened with physical activity.  The physical examination showed a normal gait.  There was “very extreme” tenderness to palpation at the right inner ankle and alone the surgical scar.  The VA Compensation and Pension (C&P) neurology examination, 4 days prior to separation and general examination performed 17 days post separation showed a normal gait, 5/5 strength in all muscle groups, and intact sensation. Radiographic evaluation of the right foot showed irregularity and flattening of the navicular bone medially and minimal degenerative changes about the great toe metatarsophalangeal joint.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right lower extremity reflex sympathetic dystrophy condition 10%; (coded 8799-8722, [Musculocutaneous {superficial peroneal} nerve]); citing chronic pain analogous to neuralgia.  The VA rated the condition 10% (coded 5284, Foot injuries, other), citing foot injury resulting in moderate symptoms. The VA additionally rated the right foot surgical scar at 0% (coded 7802 [scar{s}] due to other causes).  The Board noted that IAW VASRD § 4.124 (neuralgia, cranial or peripheral) the maximum rating is equal to moderate incomplete paralysis of the involved nerve; which is a 10% rating for 8722.  The evidence did not support a moderately severe rating under 5282.  There was no evidence of a separately unfitting painful scar for an addition rating under 7804 (Scar[s], unstable or painful) or 7802.  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 right lower extremity reflex sympathetic dystrophy condition.  

BOARD FINDINGS:  In the matter of the right lower extremity reflex sympathetic dystrophy condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 21040310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160011062 (PD201401314)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA