RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00949
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E3, Automated Logistical Specialist, medically separated for “chronic bilateral non-localized leg pain” with a disability rating of 0%.

CI CONTENTION:  The CI requests a review 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 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 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 - 20060216	VARD – None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Non-Localized Leg Pain…	5099-5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Bilateral Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain condition began in Basic Training and prevented her from finishing advanced training.  There was no history of injury and radiographic evaluation failed to uncover a cause of the pain.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral lower extremity pain of unclear etiology” for PEB adjudication.

An MRI examination of the lumbar spine was performed in January 2004 to evaluate complaints of left leg pain.  A small right-sided disc protrusion at L5-S1 was noted to mildly efface the S1 nerve root, but this was deemed to be clinically inconsequential because the CI “denies any right-sided leg pain.”

The MEB NARSUM examination on 30 June 2005 (10 months prior to separation) noted that both legs were “hurting her for approximately two years.”  The CI was currently attending Reserve Drills, working in a sandwich shop 30 hours per week and a part time student.  The diffuse pain in the legs, knees and thighs prevented strenuous activity.  Walking short distances caused pain.  Physical examination showed both tibias to be tender anteriorly in the mid-shaft and proximally. Mild tenderness was present in both anterior thighs.  Lower extremity muscle strength was normal in all muscle groups.

The commander’s statement on 10 July 2005 indicated that the CI’s MOS required lifting objects up to 30 pounds and standing for extending periods.  The CI “admits there are times when her condition sometimes prevents that from happening.”  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 July 2005, the CI checked “Yes” for “Knee trouble” but “No” for “impaired use of … legs” and for “swollen or painful joints.”  She indicated that her knees “hurt and give out on me sometimes” but made no other comment about current lower extremity symptoms or lower extremity functional impairment.  The permanent physical profile dated 3 August 2005 allowed lower body weight training and walking, biking or swimming at own pace and distance.

An orthopedic addendum on 2 February 2006 (3 months prior to separation) recorded that there was no change in her symptoms since the NARSUM examination.  She was now working as a manager in an office.  Pain occurred in her legs after “standing for a long time” or from “moving from a seated to a standing position.”  She could not perform strenuous activities “except an elliptical trainer on low resistance.”  She took Tylenol occasionally for the leg discomfort, but no other medications.  Physical examination showed the CI to appear comfortable and able to heel and toe walk without difficulty or apparent discomfort.  She was able to squat normally, but with some discomfort in the front of her thighs.  There was no visible abnormality of the lower extremities, but mild tenderness was present in the anterior legs (right greater than left) and anterior distal thighs.  There was no VA Compensation and Pension (C&P) examination in evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg pain condition 0%, coded analogously to 5003 (degenerative arthritis) with application of the US Army Physical Disability Agency pain policy.  The Board first considered whether separate ratings for each extremity could be supported, but would need to satisfy itself that each extremity was reasonably justified as separately unfitting.  In this case, the chronic bilateral leg pain was treated as a combined bilateral condition (without distinguishing right versus left) in the NARSUM, the commander’s statement, and the profile.  However, in deliberating a recommendation, the Board was challenged by inconsistencies in the record.  For example, the MRI report recorded no concurrent right lower extremity pain, yet the NARSUM noted a history of bilateral lower extremity pain with onset prior to that MRI.  The commander’s statement likewise did not reflect that pain consistently interfered with performance of strenuous duty, but that it did so “sometimes.”  On the DD Form 2807, the CI indicated that her knees were “sometimes” problematic but otherwise mentioned no other problems with her legs.  It was also difficult to reconcile the reported inability to stand for prolonged periods with concurrent employment in a sandwich shop.  In debating the appropriate coding and rating for bilateral lower extremity pain, Board members acknowledged that no code ideally described the condition and associated disability, in part because there was no definitive diagnosis and no pathology on which to base a diagnosis.  In the context of apparent musculoskeletal pain, the PEB’s analogous 5003 pathway was not unreasonable, although the bilateral rating of 0% did not comport with VASRD §4.71a, which confers a 10% rating for the involvement of “2 or more major joints” (without specifying a need for additional criteria).  The orthopedic addendum (3 months prior to separation) observed the ability to squat in a normal fashion, which easily resulted in hip, knee and ankle motion exceeding the 10% range of motion thresholds for the respective joints; nor did that examination suggest painful motion (§4.59) of any of the aforementioned joints.  The Board also considered rating under analogous long bone codes 5255 (femur, impairment of) and 5262 (tibia and fibula, impairment of), and debated whether the presence of mild tenderness of anterior legs and thighs, and some thigh discomfort during squatting, but with an ability to walk on heels and toes with no apparent discomfort, described “slight” knee, hip or ankle disability.  However, members concluded that the “slight” descriptor was not characterized by the evidence at hand, and therefore a rating higher than 0% for either lower extremity was not supported.  After due deliberation, considering all 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 adjudication for the chronic bilateral leg pain condition.

BOARD FINDINGS:  In the matter of the chronic bilateral non-localized leg pain condition and IAW VASRD §4.71a, 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,