RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02954
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, UAV Operator, medically separated for “chronic bilateral lower leg pain,” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.”  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 upon a 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 - 20040310	VARD - 20041105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Lower Leg Pain	5099-5003	0%	Exertional Pain Syndrome Of The Lower Extremities	9588-8520	NSC	20040930	
Varicose Veins, Left Lower Extremity	Not Unfitting	Scars on the Left Lower Extremity, S/P Excision of Varicosities	7804	10%	20040930	
Nicotine Addiction	Not Unfitting	No VA Entry	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Lower Leg Pain Condition:  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain condition insidiously began in basic training in 1994.  In May 2002, the CI was clinically diagnosed with bilateral exertional pain syndrome.  Despite normal X-rays, a bone scan was suggestive of stress reactions in both lower extremities.  Conservative treatment measures did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic bilateral lower leg pain (chronic exertional pain syndrome)” for PEB adjudication.  At the MEB NARSUM examination on 14 January 2004, 4 months prior to separation, the CI’s physical examination was normal and the provider assessed the CI’s pain as ‘slight’ and ‘occasional’.  At the VA Compensation and Pension (C&P) examination on 30 September 2004, performed 4 months after separation, the CI reported a recent bout of bilateral lower extremity pain; “[The CI] stated that he went to the ‘clinic’ about a month ago because he was having bilateral lower extremity pain.”  His physical examination revealed a normal gait and the lower extremity neuro-vascular status was normal.  The remainder of the examination focused attention to the multiple small scars resulting from surgery for a separate condition.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the bilateral lower extremity condition and both were analogously coded IAW §4.71a and §4.124a, respectively.  The PEB utilized the Army’s Pain Policy for its rating whereas, the VA found the condition as not service connected (NSC) citing the absence of abnormal pathology.  The Board considered if each lower extremity having been de-coupled from the combined PEB adjudication, remained independently unfitting.  In consideration of separate ratings, the Board must also consider separate fitness assessments which justify each disability rating.  Board members agreed that the normality of both the NARSUM and VA examinations supported that neither extremity would have been separately unfitting and that the PEB combining both conditions under one rating was most appropriate in this case.  Therefore, 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’s adjudication of the bilateral lower extremity pain condition.    

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that varicose veins of the left lower extremity and nicotine addiction were not unfitting.  Neither condition was profiled, implicated in the commander’s statement, or judged to fail retention standards.  The conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the varicose veins of the left leg or nicotine addiction.

BOARD FINDINGS:  In the matter of the bilateral lower leg pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.   In the matter of the contended varicose veins of the left lower extremity and nicotine addiction conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140522, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160013883  (PD201402954)

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