RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00419
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Rifleman, medically separated for “complex regional pain syndrome [CRPS] left leg and foot” rated 20%.  

CI CONTENTION:  “Consider all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 – 20040420	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
CRPS Left Leg & Foot	8799-8720	20%	No VA Exam in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

CRPS Left Leg and Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s foot condition began in June 2002 after falling on the stairs.  Ankle surgery (removal of os trigonum, and peroneal ligament exploration) was performed in November 2002.  Persistent pain resulted in a diagnosis of regional pain syndrome in February 2003.  

The 10 February 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of activity-related plantar heel and lateral ankle pain that limited walking to ½ mile, prevented running, and inability to wiggle his toes.  He reported occasional skin discoloration, swelling with ambulation, and sensory changes (numbness, and shooting pain from heel to knee with weight bearing activity).  The physical examination showed an antalgic gait, diffuse foot and ankle swelling, and weakness of dorsiflexion (2/5), plantarflexion (3/5), eversion/ abduction (3/5), and inversion/adduction (3/5).  Passive range of motion (ROM) was as follows: dorsiflexion of 0 degrees (normal 20) and plantarflexion of 35 degrees (normal 45).  There was hypersensitivity in the sural nerve distribution, sensitivity over the “maturing” incisions, and normal sensitivity elsewhere.  During the 11 March 2004 MEB examination (recorded on DD Form 2808), 4 months prior to separation, the physical examination showed tenderness from the ankle to the heel, with decreased sensation from the forefoot to the toes, and decreased ROM on flexion and extension of toes.  

There was no VA examination in evidence within the 12-month allowable window for adjudication.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the left foot and leg RSD condition, coded 8799-8720 (neuralgia of the sciatic nerve).  The panel considered the evidence for a higher than 20% rating.  The VASRD §4.124a (schedule of ratings for neurologic conditions) defines ‘incomplete’ paralysis as a degree of lost or impaired function “substantially less than” the type pictured for ‘complete’ paralysis.  It further states that “when the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree.”  

There was no STR evidence of foot drop, slight droop of all toes, or the inability to evert/abduct the ankle or foot that would support the higher 40% rating for ‘complete’ paralysis.  There was no STR evidence of repeated falls that would support a ‘severe’ incomplete paralysis.  However, there was STR documentation of decreased flexion and extension of the toes, weakness of dorsiflexion, plantarflexion, eversion/ abduction, and inversion/adduction, and decreased sensation along the dorsal foot and toes, in support of a 20% rating for ‘moderate’ incomplete paralysis.  In consideration of the severity of symptoms and disability in evidence (IAW §4.40 and §4.45), members agreed that the “incomplete moderate” 20% rating for the left RSD condition was appropriately recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot and leg RSD condition.  

BOARD FINDINGS:  In the matter of the left foot and leg RSD condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated «ApplicationDate», w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 10 May 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

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