RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01313
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic left thigh pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20051101	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Thigh Pain Secondary to Shrapnel Wound…	5099-5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:	

ANALYSIS SUMMARY:  

Chronic Left Thigh Pain Secondary to Shrapnel Wound….  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left thigh condition began in August 2003 after a shrapnel wound.  The shrapnel could not surgically be removed due to its proximity to vital structures, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

At a May 2005 primary care visit, 7 months prior to separation, the physical examination showed tenderness of the thigh with pain during flexion and extension of the left leg.  There was decreased strength (3/5) of the thigh (quadriceps) muscle due to pain.  At the June 2005 MEB examination (recorded on DD Form 2808), 6 months prior to separation, the physical examination showed a healed scar, no palpable masses or swelling, and full range of motion.  The 4 August 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain and inability to run, jump, march, or lift and carry more than 25 pounds.  There was no VA Compensation and Pension (C&P) evaluation proximate to separation in evidence for review.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the left thigh condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing ‘constant, minimal’ pain IAW the US Army Physical Disability Agency pain policy.  The panel considered the evidence for rating.  IAW VASRD §4.56-1c, the evaluation of muscle injuries should take into consideration the ‘cardinal signs and symptoms of muscle disability’ which include ‘loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement.  A ‘moderate’ disability rating stipulates a record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability, in addition to objective findings of impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side.  A ‘moderately severe’ disability rating stipulates a history of debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring; hospitalization for a prolonged period of treatment of [the] wound; evidence of inability to keep up with work requirements; and objective findings of loss of deep [muscle] fascia, muscle substance, or normal firm resistance of muscles compared with the sound side.  There was STR evidence of a wound caused by shrapnel without explosive effect, residuals of debridement, or prolonged infection.  The STR documented pain and decreased strength during extension and flexion of the quadriceps muscle.  There was consistent complaint of muscle pain with objective findings of an entrance scar and loss of power in support of a 10% rating for ‘moderate’ muscle disability under code 5314 (Group XIV).  There was no documentation of prolonged infection for treatment of the wound, no objective findings of ragged or adherent scars indicating wide damage to muscle, or abnormal swelling or hardening of the muscles during contraction, and no evidence of intramuscular trauma and explosive effect to warrant a muscle rating higher than ‘moderate.’  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left thigh condition, coded 5314.  

BOARD FINDINGS:  In the matter of the chronic left thigh pain condition, the panel unanimously recommends a disability rating of 10%, coded 5314 IAW VASRD §4.56 and §4.73.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Thigh Pain Due to Shrapnel Injury	5314	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record

AR20170007552, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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