RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03755
BRANCH OF SERVICE: Army	 SEPARATION DATE:  20050818

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Infantryman, medically separated for “left lower extremity pain” and “myofascial pain of right shoulder,” rated 10% and 0%, respectively, with a combined rating of 10%.

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 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 - 20050711	VARD - 20051222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Lower Extremity Pain 	8725	10%	Peripheral Neuropathy, LLE	8525	10%	20051108	
Myofascial Pain, Right Shoulder	5021	0%	Myofascial Pain…R Shoulder	5021	10%	20051108	
Cervical and Lumbar Spine Pain	Not Unfitting	Myofascial Pain Syndrome, Back	5021	10%	20051108	
		Cervical DJD	5242	30%*	20051108	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Left Lower Extremity (LLE) Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) Narrative Summary (NARSUM), the CI fractured his left ankle on 8 October 2004.  It was not displaced and he was treated with a splint and crutches.  The neurological examination was normal and he was advanced to weight bearing after a week.  After a month, an X-ray was normal, but he reported irritation from the cast boot.  He also noted abnormal sensations over the lower leg and foot.  Electrodiagnostic testing on 10 February 2005 was abnormal with a left tibial neuropathy present and thought to be secondary to a puncture wound.  He was treated with various pain medications without improvement sufficient to return to full duty.

At the MEB examination on 12 May 2005, 3 months prior to separation, the CI reported ongoing left ankle pain and the use of a brace.  On examination, the range of motion (ROM) of the ankle was painful and the gait slow.  The MEB NARSUM was dated 15 June 2005, 2 months prior to separation, which recorded the CI’s inability to meet duty requirements due to the left lower extremity pain.  The physical examination was not documented.  He was diagnosed with LLE neuropathic pain.

At the VA Compensation and Pension (C&P) examination performed on 8 November 2005, 3 months after separation, the CI reported LLE pain since the ankle fracture.  He could drive, but reported walking was limited to 1-3 blocks.  He did not have a brace, but did have a cane which was used for prolonged (>3 blocks) walking.  He initially had a normal gait, but after a 25 minute walk, he reported pain and held the left leg stiffly.  All movements were slow and protective.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the LLE pain 10%, coded 8725 (neuralgia of the posterior tibial nerve).  The VA also rated the LLE neuropathy at 10%, but coded it 8525 (paralysis of the posterior tibial nerve).  The Board noted that the VA also rated the CI 10% for residual pain from the left ankle fracture.  The Board also noted that assigning two ratings for the LLE pain appeared to be a violation of VASRD §4.59 (avoidance of pyramiding).  The Board considered the findings and determined that the code 8725 better described the clinical picture.  However, for a mild condition, the rating is the same for either code and neither provided a rating advantage to the CI.  After due deliberation in consideration of the preponderance 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 fitness determination for the LLE pain condition.

Myofascial Pain, Right Shoulder.  According to the STR and MEB NARSUM, the right-hand dominant CI reported the insidious onset of neck and shoulder pain in early March 2005.  He had tenderness over the neck and shoulder muscles and was thought to have myofascial pain syndrome.  He was treated with medications, injections, and physical therapy without benefit.  At a physical therapy appointment on 7 June 2005, he reported that the pain began in October 2004 when he fell down stairs (the same time as the ankle fracture above).  At the MEB examination, 3 months prior to separation, the CI had tenderness over the anterior right shoulder.  Movement was painful but unrestricted.  Strength was noted as 4/5, but sensation and grip were normal.  The MEB NARSUM, 2 months prior to separation, recorded the shoulder pain prevented push-ups, swimming, and firing a rifle.

At the VA C&P examination, 3 months after separation, the CI reported constant sharp pain in the right shoulder blade, but not the collar bone.  He was able to bath and dress himself as well as drive.  The ROM was full for both shoulders, but accompanied by grimacing.  X-rays were normal other than what was thought to be a benign bone cyst.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated myofascial pain of (the) right shoulder and right upper extremity without limitation in range of motion at 0% and 10%, respectively, coded 5021 (myositis).  The Board agreed that painful motion was cited by both the MEB NARSUM and VA C&P examinations which support a 10% rating.  No other criteria were found to support a higher rating.  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 shoulder condition, coded 5021.

Contended PEB Conditions:  Cervical and Lumbar Spine Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  These conditions were not profiled at separation and were judged to meet retention standards.  The back pain was implicated in the commander’s statement as a condition that limited duty, but without further specification.  X-rays of the thoracic and lumbar spine were normal as was an MRI of the lumbar spine.  During the VA C&P examination, the CI refused to forward flex past 65 degrees, but then was able to bend forward to pick up his jeans off of the floor.  The cervical and lumbar spine pain condition was reviewed and considered by the Board.  There was no performance based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  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 contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left lower extremity pain condition IAW VASRD §4.124 and VASRD §4.71, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the myofascial pain, right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5021 IAW VASRD §4.71.  In the matter of the contended cervical and lumbar spine pain 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.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Left Lower Extremity Pain	8725	10%	
Myofascial Pain, Right Shoulder	5021	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140805, 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 XXXXXXXXXX, AR20160011763 (PD201403755)

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