RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03695
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Chemical, Biological, Radiological and Nuclear Specialist, medically separated for “right ankle complex regional pain syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20040617	VARD - 20050330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle, Complex Regional Pain Syndrome	8799-8722	10%	Reflex Sympathetic Dystrophy…	5271-8525	20%	20050218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle; Complex Regional Pain Syndrome (CRPS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began after fracturing her distal fibula (outside ankle bone) on 18 November 2003, while in basic training.  Despite prolonged immobilization, the CI’s pain surrounding her right ankle worsened and in February 2004 she was diagnosed with CRPS.  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right ankle CRPS, reflex sympathetic dystrophy (RSD), right nondisplaced fibular fracture, which is well healed” for PEB adjudication.

At the MEB NARSUM examination performed 2 months prior to separation, the CI reported right ankle pain causing the inability to run, jump, ruck march, or balance weight on the right lower extremity.  Pain relief was minimally decreased with applied heat and elevation of the right leg.  Her physical examination (PE) revealed an antalgic limp.  The right ankle was mildly swollen with evidence of hypersensitivity to touch.  Range of motion (ROM) was decreased and there was no comment with regards to painful motion.  At the VA Compensation and Pension (C&P) examination, performed 7 months after separation, the CI reported constant right ankle pain and swelling with pain extending up towards her right hip.  Her PE revealed the CI walked with the assistance of two crutches without bearing any weight on the right leg.  There was severe pain with “feather-like” touch to all aspects of her right ankle and foot.  Her ankle ROM was decreased.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB analogously applied the VASRD nerve code 8722 (neuralgia, superficial peroneal nerve) and arrived at a 10% rating, for ‘moderate’ impairment under §4.124a criteria.  The VA dual coded under §4.71a and §4.124a (5271-8525; limitation of ankle motion-incomplete paralysis of posterior tibial nerve) at 20%.  The VASRD guidelines are clear in that rating CRPS, one is referred to RSD criteria, which further states that such a condition is to be analogized under the most affected peripheral nerve code.  Board members deliberated and agreed that the most clinically appropriate non-ROM nerve code in this case is 8622 (neuritis; superficial peroneal nerve) because it is a specific fit for the evidenced condition and the most common affected nerve in a distal fibular fracture.  Members further agreed that in light of the CI’s ability to walk at least a quarter of a mile, as well as gaining some relief with heat and elevation, her condition would not support a nerve rating greater than “moderate” impairment equaling a rating of 10%.  The Board additionally considered a ROM code of 5271 with either a 10% (moderate) or 20% (marked) impaired motion and concluded that the inability to dorsiflex the ankle near the time of separation supported the higher 20% impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board therefore recommends a disability rating of 20% for the right ankle condition, coded 5271. 

BOARD FINDINGS:  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 20%, coded 5271 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	
Right Ankle; Complex Regional Pain Syndrome	5271	20%	

The following documentary evidence was considered:

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

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017205  (PD201403695)

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 20% 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