RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-04020
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “reflex sympathetic dystrophy (complex regional pain syndrome), right leg" with a disability rating of 20%.  

CI CONTENTION:  The CI requested consideration of 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 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 - 20081211	VARD - 20090928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy…	8699-8624	20%	Reflex Sympathetic Dystrophy, Right Leg 	8526	20%	20090819	
COMBING RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome), Right Leg.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right leg reflex sympathetic dystrophy condition began in February 2008 when he sprained his right ankle while preparing for deployment. He was treated, and he recovered to the point where he was able to run and exercise.  A short time later, while deployed overseas, he re-injured the right ankle, and was evacuated from theater.  He was evaluated and was diagnosed with complex regional pain syndrome (CRPS) of the right lower extremity (RLE).  Due to the chronic, persistent nature of his pain, an MEB was initiated.  The MEB forwarded “complex regional pam syndrome, right lower extremity” for PEB adjudication.  The MEB NARSUM was dated 29 October 2008.  The CI reported that his pain was constant, and was associated with numbness, tingling, and color changes of the RLE.  He was taking medication for the pain, and was also using a transcutaneous electrical nerve stimulation (TENS) unit.  He reported that the TENS unit helped slightly, but did not give any significant long term relief.

On physical examination (PE), the CI was in no acute distress.  He was wearing a “Cam” boot, and his gait was antalgic.  Focused PE of the RLE revealed no swelling.  Skin color was normal, except for some minor, very mild brownish discoloration.  Neurological examination revealed hypersensitivity to touch in the RLE.  Reflexes and proprioception were normal.  Ankle range of motion (ROM) was measured, and is summarized in the chart below.  

The CI separated from service in January 2009.  Seven months later, he had a VA Compensation and Pension (C&P) examination.  He reported that his RLE condition caused pain, stiffness, swelling, tingling, and burning.  It was aggravated by long periods of walking or standing. On PE, his posture and gait were normal.  Focused PE of the RLE revealed no sign of muscle wasting or atrophy.  Patellar reflex and Achilles reflex were normal.  Neurological examination was normal, except for hyper-response to pinprick testing.  PE of the right ankle was normal.  The ROM evaluations in evidence which the Board weighed in arriving at its recommendation, are summarized in the chart below.

Right Ankle ROM
(Degrees)	PT ~3 mos. Pre-Sep	VA C&P ~7 mos. Post-Sep	
Dorsiflexion (20 Normal)	15	20	
Plantar Flexion (45)	25	45	
Comments	Painful motion	No pain with motion	

The Board directed attention to its rating recommendation based on the evidence.  The PEB coded the condition 8699-8624 (analogous to neuritis of the internal popliteal nerve), and rated it 20% (moderate impairment).  The VA used VASRD code 8526 (paralysis of the anterior crural nerve).  The VA also assigned a disability rating of 20% (moderate impairment).  The MEB NARSUM examination was just 12 weeks before separation, and therefore had significant probative value.  At that examination, the CI had an obvious limp in the RLE.  Neurological examination revealed hypersensitivity to touch.  Ten months later, at the August 2009 C&P examination, his condition had improved, and his gait was normal.  Based on a thorough review of the record, the Board determined that, at DOS, the CI’s level of disability was best described as “moderate.”  There was insufficient evidence to support a conclusion that his impairment was “severe.”    

With time, the CI regained his ankle ROM.  But, the limited ROM at his NARSUM examination supports the conclusion that his RLE condition was moderately disabling at his DOS.  IAW the VASRD §4.124a, a rating of 20% is warranted for moderate impairment under diagnostic code 8699-8624 (analogous to neuritis of the internal popliteal nerve).  A rating of 20% is also in agreement with what the CI was granted by the VA.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting RLE condition (Reflex sympathetic dystrophy).  

BOARD FINDINGS:  In the matter of the unfitting RLE condition (Reflex sympathetic dystrophy), the Board unanimously recommends no change in the PEB adjudication.  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 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 
AR20160017775   (PD-2014-04020)

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