RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01704
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “multiple joint pains with joint laxity,” with a disability rating of 0%.

CI CONTENTION:  The CI contends his bunion, ankle, right shoulder and right pinky finger continue to worsen and negatively impact daily activities.  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 – 20060831	VARD- NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Joint Pains with Joint Laxity	5099-5003	0%	No VA Claim in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Multiple Joint Pains with Joint Laxity in the setting of Marfan’s Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented 9 October 2004 with complaints of 3 days of intermittent chest pain.  The CI underwent an extensive work-up to exclude pulmonary embolus, aortic dissection, coronary artery disease and asthma, all of which were negative.  In the setting of someone with suspected Marfan’s syndrome, all of his physicians were concerned that although the diagnostic work-up was negative the CI continued to have chest pain with and without exertion.  The CI was treated with multiple medications and his chest pain was not adequately controlled to allow for unrestricted activity.  The MEB forwarded “Marfan’s Syndrome” for PEB adjudication.  

At the 24 February 2004 Emergency Department visit for a sprained left ankle the examination showed no laxity of the ankle joint.  At the 31 January 2006 Internal Medicine clinic visit the examiner noted a positive wrist sign and a positive thumb sign which indicated longer than usual digits but did not speak to joint laxity.  
	
At the 6 March 2006 Rheumatology evaluation for Marfan’s syndrome the examiner took note of multiple ankle sprains while playing basketball, joint pains that were self-treated with ibuprofen, no history of scoliosis, no history of optic lens dislocation and no history of spontaneous pneumothorax.  The examiner reviewed the results of the extensive evaluation for the CI’s recurring complaint of chest pain which included several echocardiograms (all normal), ventilation/perfusion scans to rule out pulmonary embolus, chest CT scans, an exercise stress test to evaluate for coronary artery disease and a methacholine challenge test to rule out asthma; all were normal.  The examiner recorded that the CI’s family history was significant for his maternal grandmother, mother, two siblings, a maternal uncle and the CI’s son all had Marfan’s syndrome and that the CI had been diagnosed with Marfan’s syndrome at age 14.  Physical examination showed a normal heart and lung evaluation, no pectus excavatum or carinatum, all joints showed full range of motion with no hypermobility or laxity.  The examiner did confirm the positive thumb and wrist signs and that his arm spin to height ratio is 1.03 which is within normal limits.  The examiner concluded that the CI did not meet the criteria for the diagnosis of Marfan’s syndrome but that with his chest pain, family history of Marfan’s syndrome and some signs of Marfan’s syndrome it was in the best interest of the CI to be separated.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2006, 5 months prior to separation, the CI reported a right shoulder injury in 2003 that he still had some joint pain from but that it did not significantly limit him and a history of a right ankle sprain that he still had joint pain associated with but that he was still able to play basketball.  Physical examination showed the right ankle had full active range of motion and was not tender to palpation.  The MEB NARSUM examination on 17 May 2006, 5 months prior to separation, noted complaints of daily, sharp, non-exertional chest pain that did not interfere with performance of his duty.  In addition, the CI had multiple joint pains (mostly ankle sprains associate with playing basketball).  Physical examination showed a tall stature and borderline abnormal arm span to height ration with arachnodactyly (abnormally long fingers).  There was no VA Compensation and Pension evaluation proximate to separation in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the joint condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  There was no indication of X-ray evidence of arthritis to support even a minimal rating using VASRD code 5003 (arthritis, degenerative).  There was no evidence of fracture with nonunion or malunion of the ankle to support a rating using code 5262 (tibia and fibula, impairment of).  There were no examinations in evidence that showed a limitation in ankle range of motion or deformity to support a rating using codes 5270 (ankle, ankylosis of), 5271 (ankle, limited motion of), 5272 (subastragalar or tarsal joint, ankylosis of), 5273 (os calcis or astragalus, malunion of) or 5274 (astragalectomy).  There was no evidence of increased laxity or flexibility from flail joints, bone resections, nonunion of fractures or relaxation of ligaments to support ratings under respective joints.  There were no evaluations in evidence that documented painful motion to support a minimum compensable rating based on VASRD §4.59.  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 multiple joint pains with joint laxity condition.  

Contended PEB Conditions:  Hallux Valgus.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was 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 the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the multiple joint pains with joint laxity condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hallux valgus condition, the Board unanimously recommends no change from the PEB determination 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 20150630, w/atchs
Exhibit B.  Service Treatment Record

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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,