RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01686
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Transport), medically separated for “chronic bilateral lower extremity pain,” with a disability rating of 10%.  

CI CONTENTION: Her conditions continue to worsen and negatively impact her daily activities.  Her 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 - 20061207	VARD - 20080625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Lower Extremity Pain	5099-5022	10%	Chronic Bilateral Extremity Pain to Include Knees, Hips and Ankles	5099-5020	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Lower Extremity Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower extremity pain condition began after a long road march in January 2006.  There was no history of direct trauma.  An acute care encounter dated 22 February 2006 revealed the presence of “…moderate tenderness multiple areas of knees, tibias and feet.”  An initial bone scan performed on the same day revealed findings consistent with stress fractures in both heels, ankles, and knees.  The CI’s treatment consisted of physical restrictions, medication, and physical therapy (PT).  A repeat bone scan performed on 23 May 2006, 7 months prior to separation, specifically stated the findings as, “There is no abnormal focal increased uptake to suggest fracture.”  Increased uptake in bilateral knees, ankles and feet are likely related to arthropathy (inflammatory type arthritis).  

The 30 May 2006 MEB NARSUM examination, 7 months prior to separation, the CI’s chief complaint remained bilateral lower extremity pain; 7/10 at rest and 10/10 with activities such as walking.  Her physical examination (PE) revealed a normal gait and near normal range of motion (ROM) of both ankles and knees.  There was no comment with regards to the presence of painful motion.  Tenderness was present over the top of both feet as well as the mid-aspect of both lower legs.  There was no VA Compensation and Pension (C&P) examination pertaining to the joints contained in the case file because the CI was a “no show” for the 1 April 2008 C&P appointment.  Therefore, the panel’s final impairment rating recommendation will be based upon the STR and MEB-driven documents.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral lower extremity pain condition at 10%, analogously coded 5022 (periostitis), citing performance inabilities within her MOS.  The VA noted the same condition as not service connected (NSC) under the analogous code of 5020 (synovitis).  

The panel first considered whether each lower extremity [leg] condition remained separately unfitting, having decoupled them from the combined (bilateral) PEB adjudication.  Panel members carefully reviewed the chronological STR during the 2 year pre-separation period and the majority of members agreed that the CI’s overall condition, isolated treatments, and generally unchanging clinical symptoms did not significantly center about either leg independently, but rather a bilateral condition.  Panel majority found it reasonable to surmise that it was the combination of pathology from both lower extremities that rendered the CI unfit to perform her MOS duties.  Furthermore, the bilateral diagnosis does support the single 5003 [10%] based rating for “2 or more major joints;” thus there is VASRD §4.71a latitude for a bilateral rating in this case.  In regards to specific and alternative rating criteria, all members agreed that there was no limitation of motion of the lower extremity joints which would support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261, 5271) or instability under codes 5257 or 5262.  Additionally, all member’s concluded that the primary coding scheme of 5003 was a good analogy to the pathology in this case.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a bundled disability rating of 10% for the chronic bilateral lower extremity pain condition.  

BOARD FINDINGS:  In the matter of the bilateral lower extremity pain condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to separate unfitting determinations with a 10% rating to each lower extremity for a combined rating of 20% and did not elect to submit a minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008713  , XXXXXXXXXXXXXXXXXX 

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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,