RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01533
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Medic, medically separated for “chronic right lower extremity (RLE) pain secondary to complex regional pain syndrome (CRPS),” with a disability rating of 10%.

CI CONTENTION:  The CI contends 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 - 20070308	VARD - 20080407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic RLE Pain Secondary To CRPS	8799-8722	10%	Fibromyalgia (Claimed as RSD	5025	10%	20070821	
Fibromyalgia Syndrome	Not Unfitting					
Anxiety	Not Unfitting	Major Depressive Disorder (Claimed as PTSD)	9434	10%	20071204	
Low Back Pain		No VA Entry				
Headaches		Chronic Headaches	8100	Not Service Connected	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Lower Extremity Pain Secondary to Complex Regional Pain Syndrome(CRPS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pain condition began with her foot in late 2003 while running.  She was initially treated for bilateral shin splints and plantar fasciitis.  In 2004 she was noted to have inflammation of the sesamoid bones (accessory bones near the toes) of the right foot on a bone scan done on 15 November 2004.  She was treated with a cast and crutches, but her pain persisted.  On 26 January 2005 in physical medicine, she was noted to have abnormal sensation and coolness of the right foot and diagnosed with Type I CRPS, a chronic pain condition thought to be from damage to part of the nervous system after an injury.  She was treated with orthotics (shoe inserts), anti-depressant medications, injections, nerve blocks, and physical therapy.  A repeat bone scan on 14 December 2005 showed that the underlying sesamoid bone inflammation was resolving.  Her symptoms persisted though.  She was seen in rheumatology and the diagnosis of fibromyalgia added on 11 May 2006 for longstanding symptoms of this disease process.  It was thought to be secondary to the CRPS.  In pain management on 27 June 2006, it was noted that her symptoms had improved with treatment and that the previously noted physical changes in her foot were resolved.  However, she was not able to return to full duty and entered into the MEB process.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 October 2006, 7 months prior to separation, the CI reported a swollen and painful right foot since she injured it in 2003.  On examination, she was noted to have tenderness, but to be without skin changes (associated with CRPS).  In physical therapy on 14 November 2006, 6 months prior to separation, she was noted to have decreased rotation of her right foot when walking.  On examination, dorsiflexion (toes up) was reduced to 15 degrees (20 is normal) and plantar flexion (toes down) was reduced to 40 degrees (45 is normal).  Motor function was also diffusely reduced to 4+/5.  There were no swelling, temperature, or color changes compared to the other foot.  The CI continued treatment in physical therapy.  The MEB NARSUM examination was dated 13 February 2007, 3 months prior to separation.  The CI reported that she could walk up to 1 mile.  The pain had progressed up her leg over time, but the discoloration and pain had overall improved.  The physical examination from 12 October 2006 for the DD Form 2808 was referenced for physical findings.  The MEB forwarded right foot CRPS for PEB adjudication.  

At the VA Compensation and Pension (C&P) evaluation performed on 21 August 2007, 3 months after separation, the CI reported that she had stopped all of her medications.  Her pain persisted, but she treated it with wearing comfortable walking shoes and stretching prior to exercise.  On examination, the gait was normal.  The foot was tender to palpation, but the examination was otherwise unremarkable.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic RLE pain secondary to CRPS at 10%, coded 8799-8722 (analogous to neuralgia of the superficial peroneal nerve) at a moderate level of impairment.  It was noted that she had improved, but that still precluded full duty performance.  The VA did not rate the CI for CRPS, but rather for fibromyalgia at 10%, coded 5025 (fibromyalgia) noting the need for continuous medication and tender points.  The Board observed that the CI was, in fact, off of all medications at the time of the VA C&P examination.  The Board observed that the 8799-8722 code used by the PEB is the best clinical fit for the unfitting condition.  A severe level of impairment was not present to support a higher 20% rating.  The VA examination documented a normal gait and the ability to walk 1 mile off of medications.  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 RLE pain secondary to CRPS condition.  

Contended PEB Conditions:  Fibromyalgia, Anxiety, Low Back Pain, and Headaches.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled and all were judged to meet retention standards.  There was not a commander’s assessment in evidence.  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 chronic right lower extremity pain secondary to complex regional pain syndrome condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended fibromyalgia, anxiety, low back pain, and headaches conditions, the Board unanimously 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006628, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

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,					       
						      					
Enclosure