RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01470
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “reflex sympathetic dystrophy [RSD]”, with a disability rating of 0%.  

CI CONTENTION:  The CI states that he has RSD and permanent nerve damage and small airway damage and that the military found this but never connected.  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 - 20070315	VARD - 20070806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy (RSD)…	8799-8720	0%	Residuals of Right Lower Leg-RSD	5099-5021	10%	20070627	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s RSD condition began in August 2006 after a parachuting accident.  Radiographic evaluations (X-Rays and Computerized tomography [CT]) in October 2006 showed no evidence of fracture, dislocation, arthritic or inflammatory changes; further imaging (MRI) showed mild multilevel degenerative disc disease.  After continued pain, he was diagnosed with RSD in December 2006.  

At a 5 December 2006 physical therapy visit, 5 months prior to separation, the physical examination showed ankle tenderness, effusion, with an antalgic gait, and inability to perform heel raise, and heel to toe walk due to ankle pain.  Ankle dorsiflexion was to 5 degrees (normal 20) and plantar flexion was to 40 degrees (normal 45) without evidence of instability.  At a 14 December 2006 physical therapy visit, the CI reported that physical therapy aggravated the pain, which was located in the anterior ankle, both medially and laterally.  The physical examination showed tenderness over the anterior and medial ankle with painful motion.  There was no evidence of weakness or sensory abnormalities.  

During the February 2007 MEB examination (recorded on DD Form 2808), 3 months prior to separation, the CI reported pain around the ankle, posterior calf, thigh, buttock and inguinal area.  Physical examination showed normal sensation, and 5/5 strength.  The 28 February 2007 MEB NARSUM examination noted complaints of pain in the right lower extremity worsened by physical activity, and prolonged sitting and standing.  The physical examination showed normal strength (5/5) and sensation.  

At the 28 June 2007 neurologic VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported constant pain with flares.  The physical examination showed a normal gait, and heel to toe walk with normal strength and intact sensory testing.  The ankle showed full ROM without pain.  The examiner concluded “no abnormality of the autonomic nervous system or loss of skin appendages” in the affected extremity.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the RSD condition, analogously coded 8799-8720 (neuralgia, of the sciatic nerve), citing a normal strength and sensory examination with no evidence of skin or temperature changes, and no radiographic evidence of bony pathology.  The VA rated 10% for the RSD condition, analogously coded 5099-5021 (myositis), based on the C&P examination 1 month after separation, citing pain and functional loss.  

IAW VASRD §4.124a, Diseases Of The Peripheral Nerves, the term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve …”   It further states that “when the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree.”  

Under code 8720 (neuralgia of the sciatic nerve), a ‘mild’ degree of impairment would confer a 10% rating, while a ‘moderate’ degree of impairment would be rated 20%.  Panel consensus was that a fair threshold for the ‘moderate’ rating should entail functionally significant motor and/or sensory impairment encroaching on some occupational tasks, and this was not in evidence.  The STR documented no evidence of impaired gait, repeated falls, or weakness of the right lower extremity as a result of the RSD condition in support of a ‘moderate’ disability rating.  The MEB, NARSUM, and C&P examinations consistently documented the right lower extremity pain, with a normal gait, strength and sensation that was best characterized as ‘mild.’  Members agreed that the ‘incomplete mild’ 10% rating for the left RSD condition could be recommended.  The panel also considered alternative joint coding, however, none would be of benefit to the CI.  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 RSD condition, analogously coded 8799-8720.  

BOARD FINDINGS:  In the matter of the RSD condition, the panel unanimously recommends a disability rating of 10%, coded 8799-8720 IAW VASRD §4.124a.  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	
Reflex Sympathetic Dystrophy, Right Lower Extremity	8799-8720	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008513, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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