RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03870
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Indirect Fire Infantry, medically separated for       “reflex sympathetic dystrophy, right ankle and foot,” with disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions, to include Sleep apnea, left knee, back and neck 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:  

IPEB - Dated 20030422	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy, Right Ankle and Foot	8799-8720	10%	Reflex Sympathetic Dystrophy, Right Knee, Right Ankle	8520	20%	20031115	
Chronic Right Knee Pain	Not Unfitting					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20040121 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY 

Reflex Sympathetic Dystrophy, Right Ankle and Foot.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle and foot condition began in 2001 after a twisting injury. In 2002 the CI was diagnosed with reflex sympathetic dystrophy (RSD) (a chronic pain condition also known as complex regional pain syndrome [CRPS]).  Radiographic studies were normal.  The CI used a cane for ambulation.  There was no surgical indication.  The NARSUM physical examination demonstrated right foot swelling, redness, and tenderness to palpation.  

At the VA Compensation and Pension (C&P) examination on 15 November 2003 performed 3 months after separation, the CI reported swelling of the right leg and ankle and pain made worse with walking.  He used narcotic and anti-inflammatory medications for pain.  The pain was rated 7/10 with flares 3 times per week to 10/10.  On physical examination there was diffuse tenderness to palpation over the right thigh, knee, ankle, and lower leg without skin changes or evidence of hypersensitivity.  The examiner noted that the CI had an antalgic gait and used a cane for ambulation.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right foot and ankle RSD condition 10%, coded 8799-8720 (analogous to mild sciatic nerve neuralgia).  The VA rated the right knee, ankle and foot RSD 20%, coded 8520 (sciatic nerve paralysis) citing moderate incomplete paralysis.  The Board considered whether the RSD was mild, moderate or higher in severity. All Board members agreed that the right lower extremity RSD more closely approximates the criteria for a moderate rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 20% for the RSD condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that chronic right knee pain was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The condition was not profiled, but was implicated in the commander’s statement and judged to fail retention standards.   The right knee condition was reviewed and considered by the Board.   There was minimal performance based evidence from the record that the right knee 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 condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right ankle and foot RSD condition, the Board unanimously recommends a disability rating of 20%, coded 8799-8720 IAW VASRD §4.71a.  In the matter of the contended chronic right knee condition, 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 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	
Reflex Sympathetic Dystrophy Right Ankle and Foot 	8799-8720	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140820, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear 

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure