RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01102
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Armament Systems Journeyman, medically separated for “liposarcoma” with a disability rating of 20%.

CI CONTENTION:  The CI requests the panel review 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 - 20050201	VARD - 20060104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Liposarcoma	5329-8726	20%	Status Post Excision Liposarcoma	8540-5313	0%	20050705	
Hypertension 	Not Unfitting	Hypertension	7101	0%		
Low Back Pain 		Lumbosacral Strain…	5237	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Liposarcoma.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s liposarcoma condition began in August 2002 when he noticed a large lump on his left thigh.  The lesion was excised and biopsy showed liposarcoma.  The CI underwent a second surgery in October 2002, which removed a great deal of muscle from his left thigh.  Metastatic disease was not present and his surgery was followed by 8 weeks of radiation therapy.  After the second surgery, the CI began to experience pain and discomfort in the left thigh.  Despite treatment with medication and therapy, his pain continued and he was referred to the MEB.  

The MEB NARSUM examination on 21 November 2004, 4 months prior to separation, noted complaints of leg pain that occurs daily located on his left inner thigh, where he had surgery.  He had shooting pain and numbness radiating down his leg at times that was exacerbated by certain movement.  He cancelled missions and engagements and professional appointments due to the pain in his leg.  He was unable to drive, which was an important function of his service duties.  A magnetic resonance imaging (MRI) study conducted 3 weeks prior to the NARSUM showed post-operative and post-radiation changes in the proximal medial left thigh, included thickening and muscle volume loss.  There was no evidence of return of his liposarcoma.

Physical examination of the musculoskeletal showed a well-healed scar in the area of surgery and significant atrophy of the thigh muscles with some areas of the muscles “that actually appear to be missing.”  Hip range of motion (ROM) was limited to “just over 90 degrees” flexion (125 Normal), adduction was to 45 degrees (normal) on the left and 60 degrees on the right (45 normal).  Motor strength of the left hip was slightly reduced.  Knee flexion was normal bilaterally.  Gait and balance was normal.  The examiner assessed chronic leg pain of somatic and neuropathic origin.

The oncology NARSUM dated 10 December 2004, 3 months prior to separation, documented the CI’s functional impairment as having “limited activity given tenderness of the local area but is able to complete his work-related activities.”  The oncologist stated that the CI “is functional and able to complete his Air Force duties as prescribed.  He has mild limitations with pain on his left lower extremity that do not impair his ability to perform his duties.”  Mild tenderness to palpation and skin thickening were the only abnormal finding in the examination of the left extremity.

At the 5 July 2005 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported his leg pain continued at a severity level of 5-10/10, occurring daily.  He was not employed.  Physical examination showed the CI had a normal stride (walked rapidly) and gait, with no assistive device.  The examiner noted that “he sits, stands, and changes body positions readily and rapidly.  The surgical scar was tender, but not elevated or depressed and was without keloid formation.  The posterior hamstring muscles on the left were decreased in total mass.  Left knee ROM recorded 95 degrees of flexion, with motion limited by pain.  Left hip flexion was 80-95 degrees, and limited by pain.  There was normal sensory function, and weakness was noted in the left hamstring muscles.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the liposarcoma condition 20%, analogously coded 5329-8726 (neuralgia, femoral nerve), citing status post excision with residual pain.  The VA rated the liposarcoma condition 10% analogously coded 8540-5313 (group XIII), based on the VA C&P examination 4 months after separation, for moderate muscle disability.  The 20% rating under the nerve code 8726 is associated with moderate degree of impairment.  The panel noted the great disparity between the findings of the NARSUM and the C&P and to some extent, the oncology NARSUM, 3 months prior to separation.  The latter 2 examinations documented significant improvement in the CI’s functional ability.  Panel members agreed the higher rating of 30% for severe impairment was not justified.  The panel identified no route to a higher rating.  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 liposarcoma condition.  

Contended PEB Conditions:  The Board’s main charge is to assess the fairness of the PEB’s determination that the hypertension and low back pain conditions were not unfitting.  The conditions were not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the liposarcoma, left leg, status post excision with residual pain condition and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication.  In the matter of the contended hypertension and low back pain conditions, the Board recommends no change from the PEB determinations as not unfitting.  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 20150610, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
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Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01102.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings