RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03405
BRANCH OF SERVICE:  Army                                                              sepAration DATE: 20070511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active E-5, Military Police, medically separated for “chronic right thigh pain,” with a disability rating of 0%.

CI CONTENTION: “Please consider all conditions.”

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 - 20070410	VARD - 20080213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Thigh Pain	5099-5003	0%	Scar, Residual of Shrapnel Wound, Right Thigh	7804	10%	20071119	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Thigh Pain. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a penetrating shrapnel injury to his right thigh in July 2005.  Surgical removal of the foreign body was not performed until 31 May 2006.  Despite successful removal of the shrapnel, the CI persisted with thigh pain.  Profiled restrictions and aggressive physical therapy did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right lateral upper thigh pain, status post shrapnel wound” for PEB adjudication.

At the MEB NARSUM examination, 26 February 2007, 3 months prior to separation, the CI reported right thigh pain with prolonged standing, running, or wearing of protective battle gear.  He denied lower extremity weakness.  His physical examination (PE) noted two separate right thigh scars measuring 8 and 2.5 centimeters without further description.  There was tenderness about the right thigh, an antalgic gait, and painful motion demonstrated as pain with squatting.  There was no evidence of muscle wasting or sensory loss.  Strength of the upper right lower extremity was normal.  Right-sided range of motion (ROM) of the hip, knee and ankle were normal.  His diagnosis remained unchanged.  At the VA Compensation and Pension (C&P) examination performed on 19 November 2007, 6 months after separation, the CI reported no new or additional complaints.  His detailed PE was normal in all clinical parameters excepting tenderness about the right thigh.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (arthritis, degenerative) citing constant pain.  The VA assigned a 10% rating using 7804 (unstable or painful scars) citing a painful scar.  All Board members agreed that the evidence of tenderness and the antalgic gait coupled with a component of painful maneuvering supported the maximum of 10% under VASRD §4.59 (painful motion).  Additionally, members further agreed that a more appropriate analogous VASRD code encompassing the unilateral condition was 5099-5021 (myositis).  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 right thigh pain condition, coded 5099-5021. 

BOARD FINDINGS:  In the matter of the right thigh pain, the Board unanimously recommends a disability rating of 10%, coded 5099-5021 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Thigh Pain	5099-5021	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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, AR20160017183 (PD201403405)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA