RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00320
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “reflex sympathetic dystrophy/complex regional pain syndrome right foot” with a disability rating of 20%.

CI CONTENTION:  Has not received any benefits.  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 - 20060427	VARD - 20120130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
RSD/CRPS Right Foot	8799-8723	20%	CRPS Right Foot	8599-8524	NSC	20110603	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Reflex Sympathetic Dystrophy (RSD)/Complex Regional Pain Syndrome (CRPS) Right Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a crush injury to the right foot in August 2004.  He was treated for bruising, but his pain persisted.  An X-ray was normal as was a repeat X-ray on 26 December 2004.  A blood clot was excluded by an ultrasound.  An MRI on 12 January 2005 showed some changes consistent with inflammation, but no evidence of a fracture or ligamentous damage.  A bone scan on 16 February 2005 was normal and did not show evidence of RSD.  Electrodiagnostic testing on 22 June 2005 was normal, but compromised by pain.  The CI was not able to tolerate all testing and while CRPS was not demonstrated, it was not excluded.  
Over the course of several years, the CI was treated with multiple modalities including physical therapy, narcotics and other medications, injections, and a spinal stimulator.  When relief was obtained, it was temporary.  

The MEB NARSUM examination was dated 06 February 2006 and revised on 23 March, 5 months prior to separation.  The CI reported severe pain, tingling, and numbness of the right foot.  He also endorsed bluish discoloration when dependent and that his foot was cold.  On examination, the gait was abnormal due to pain.  Motion was limited.  The foot was cooler than the left side.  The examination was otherwise unremarkable.  There was not a VA Compensation and Pension examination performed in proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the reflex sympathetic dystrophy/complex regional pain syndrome right foot condition 20%, coded 8799-8723 (analogous to neuralgia of the deep peroneal nerve).  The VA did not service-connect the CRPS condition.  VASRD code 8599-8524 (analogous to paralysis of the tibial nerve) was used.  No specific code is listed in the VASRD for the RDS/CRPS condition.  The 20% rating is the maximum rating available under the code 8723, for severe incomplete paralysis.  No better coding option was found and alternate codes did not provide a path to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the reflex sympathetic dystrophy/complex regional pain syndrome right foot condition.  

BOARD FINDINGS:  In the matter of the reflex sympathetic dystrophy/complex regional pain syndrome right foot condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160524, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00320.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted. I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings