RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03447
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-3, Basic Trainee, medically separated for “cranial nerve III paralysis,” rated at 10%.

CI CONTENTION:  “My rating was 40% as of 3/25/2005.  It was increased to 80% on 10/23/2008 and then I received another increase on 2/7/2011 to 90%.  I’m now asking for review to get 100% disability compensation”.  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 confined to 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 - 20050109	VARD - 20060117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
CN III Paralysis	8207	10%	Residuals Left Facial Injury…	8207	10%	20050516	
			Excessive Tearing, Left Eye	6025	10%	20050516	
Left Leg Pain secondary to Lymphedema	7199-7121	---%	Lymphedema of the Left Leg	7799-7120	10%	20050516	
Adjustment Disorder	Not Unfitting	Adjustment Disorder	9435	10%	20050504	
Low Back Pain	Not Unfitting	Degenerative Joint Disease, Lumbar Spine	5242	10%	20051117	
Headaches	Not Unfitting	Migraine Headaches	8100	0%	20050523	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

CN III VII Paralysis.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left facial nerve palsy condition began in August 2003 after her Kevlar was hit by the rifle butt of an M-16.  An electromyogram study MRI performed in September 2003 confirmed the left facial nerve palsy diagnosis.  Despite treatment, the left facial nerve palsy condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded left facial nerve palsy for PEB adjudication.

At the MEB NARSUM examination dated 22 October 2004, 5 months prior to separation, the CI reported the inability to play the French horn due to facial muscle weakness, blurred vision in the left eye, dizziness, and sensitivity to loud sounds (hyperacusis).  Physical examination showed left-sided facial drooping, decreased left eye closure, and an inability to wrinkle her forehead or move the left cheek and lips.  At a neurology evaluation in January 2005, the CI reported facial twitching, left eyelid closure with playing the French horn, left sided tearing with eating, left hyperacusis, and dysagusia (distortion of taste).  The examiner noted that the findings were consistent with residuals of an old left lower motor neuron facial palsy with involvement of the facial nerve branches to the tongue, salivary glands, and middle ear muscles.

At the VA Compensation and Pension (C&P) examination in May 2005, performed 2months after separation, the CI reported left facial weakness, decreased left eye involuntary closure, left eye dryness, blurred vision with driving and reading, left sided mouth weakness, drooling with drinking, tearing with eating, and hyperacusis.  Physical examination showed decreased left facial sensation; slight ocular divergence with cover test (the eye strays away from center or eyes do not point in the same direction); partial peripheral left nerve weakness; decreased left frowning, left eye closure, and left smile; flattening of the left nasal folds, and involuntary eye closure with voluntary activation of the mouth.  The tongue was midline and without atrophy.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the cranial nerve condition 10% coded 8207 (seventh [facial] cranial nerve), citing moderate incomplete paralysis secondary to an injury in basic training.  The VA also rated residuals left facial injury 10% coded 8207 based on the VA C&P examination 2 months after separation, citing moderate incomplete paralysis.  

The Board noted that that there was no disturbance of tongue motion or referral for surgical correction of facial muscle dysfunction.  The Board concluded that the evidence did not support a rating for severe incomplete paralysis dependent upon the relative loss of innervation of facial muscles.  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 left facial nerve palsy condition. 

Left Leg Pain secondary to Lymphedema.  According to the STR and MEB NARSUM, the CI’s left leg pain and lymphedema condition began in at the age of 16. The CI reported that the pain and swelling increased during basic training.  At the MEB NARSUM dated 22 October 2004 (5 months before separation) the CI reported daily use of knee-high compression stockings.  She reported pain and swelling of the foot and lower leg with running, sitting greater than one hour without elevating her leg, and prolonged standing and walking.  The lower extremity examination was normal.

At the VA C&P examination in May 2005, performed 2 months after separation, the CI reported sporadic left leg swelling.  He reported continued use of support stockings and pain with prolonged standing.  Physical examination showed that the CI was wearing a support stocking with no significant edema.  There was tenderness to deep palpation along the entire left lower extremity and bilateral pes planus (flatfoot).

The Board directed attention to its rating recommendation based on the above evidence. The PEB determined the left leg condition existed prior to service and was not permanently service aggravated.  The VA rated the left leg condition 10% analogously coded 7120 (varicose veins) based on the VA C&P examination 2 months after separation, citing intermittent edema after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery.

The Board first considered if the CI’s left leg was permanently service aggravated.  The CI reported a prior to service history of left leg swelling in which the MEB NARSUM examiner opined that there was “no evidence that her participation in IET [initial entry training] significantly worsened this condition.”  According to the STR the CI received a temporary profile in September 2003, 3 months after entering the service, for no outdoor activity and physical training at her own pace.  She was evaluated by a civilian provider in January 2004 with reports of pain with running and was advised to avoid running and was given a vascular surgery consult.  A permanent profile was issued in October 2004 for no standing, sitting, walking or running.  During the MEB NARSUM examination in October 2004, the CI reported that her left leg edema had worsened, but there was no objective finding of left lower extremity swelling.  During VA C&P examination 2 months after separation, physical examination showed that the CI was wearing a support stocking with no significant edema.  The Board agree with the PEB determination that the left leg condition existed prior to service and was not permanently service aggravated.

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 left lower extremity lymphedema condition.  

Contended PEB Conditions:  Adjustment Disorder with Mixed Anxiety/Depressed Mood, Personality Disorder Not Otherwise Specified with Narcissistic/Borderline Traits, Low Back Pain, and Headaches.

Adjustment disorder and personality disorder are conditions that do not constitute a physical disability.  The Board therefore has no reasonable basis for recommending these conditions as additionally unfitting for separation rating.

The Board’s main charge is to assess the fairness of the PEB’s determination that the remaining contended low back pain and headache conditions were not unfitting.  These conditions were not profiled or judged to fail retention standards.   All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left facial nerve palsy condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left lower extremity lymphedema condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with mixed anxiety/depressed mood, personality disorder NOS with narcissistic/borderline traits, low back pain, and headache conditions, the Board unanimously recommends no change from the PEB determinations 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140718, 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 
XXXXXXXXXXXXXXXXXX, AR20160017191 (PD201403447)

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