RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02417
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Cannon Crewmember, medically separated for “chronic involuntary movements of the right foot” with a disability rating of 0%.

CI CONTENTION:  The CI contended for an upgraded rating from 0% to 30% for his right foot.  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 - 20061212	VARD - 20091102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Involuntary Movements of the Right Foot	8199-8103	0%	Bilateral Foot Pain	5284	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Involuntary Movements of the Right Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed an atraumatic onset of right foot symptoms in April 2003 soon after mobilization.  These consisted of painful spasms upon any attempt at voluntary contracture of the foot, and frequent (one neurology note stated every “2-5 minutes” during the day and “all the time” at night) involuntary twitching of the foot.  A comprehensive evaluation (included foot and ankle x-rays, laboratory screening for neurologic diseases, lumbar and brain MRI, and EMG) did not yield an etiology.  

There was ample documentation in STR clinical entries of normal comprehensive neurological examinations with normal gait and coordination.  There were no STR entries to the contrary and none that documented any additional VASRD-ratable findings.  The symptoms did not improve over a protracted trial of treatment and observation, and the CI was referred for an MEB.  

The 20 July 2006 NARSUM examination, 6 months before separation, documented “the problem seems to be stable at the same level [since onset] ... gets frequent spasms associated with mild pains ... twitches and plantar flexes ... aggravated [by] running, prolonged standing, prolonged walking, or use of the foot.”  The physical examination recorded overall normal findings that included detailed neurological testing.  Goniometric range of motion (ROM) measurements of the right ankle by physical therapy were dorsiflexion to 12 degrees (normal 20) and plantar flexion to 27 degrees (normal 45), with painful motion.  There was no VA examination in evidence proximate to separation.

The PEB rated the involuntary movements of the right foot condition 0%, coded analogously as 8103 (convulsive tic) citing the condition as ‘mild’.  The VA determined the involuntary movements of the right foot condition was not service-connected based on the C&P examination 33 months after separation.  

Code 8103 is quite specific for the condition under consideration and certainly the closest clinical fit available under VASRD §4.124a.  Although the ankle ROM limitation and painful motion could be leveraged for a minimum compensable 10% rating via codes under VASRD §4.71a, members agreed that there was no logical link with the unfitting clinical pathology in this case to justify that as ratable evidence.  It was thus decided that no alternative code was reasonably applicable or justifiable even for analogous rating.  Members deliberated, however, whether a higher rating under the above criteria for code 8103 was supported.  Considering that the condition was very stable and not progressing, and that it was confined to a single foot without interfering with gait or mobility, member consensus was the evidence was better aligned with the “mild” 0% criterion than with the 10% “moderate” one.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), panel consensus was that there was insufficient cause to recommend a change in the PEB adjudication of the right foot condition.

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.124a, the panel by a majority vote recommends no change in the PEB adjudication.   The single voter for dissent recommends modification to 10% and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151002, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170012896, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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. 

	A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,					      
						      					
Enclosure