RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01016
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated from the Temporary Disability Retired List (TDRL) for “complex regional pain syndrome” with a disability rating of 20%.  

CI CONTENTION:  “I feel [my rating] was not justified and I was not evaluated at the proper level or conditions.  I was honest and made nothing up...I am asking for a fair and responsive evaluation of my condition, of the circumstances of my injury and the fact that it is going to be 10 years since my injury.  I have had no increase in my disability payments but lots of increase in my pain without compensation for it.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080604	VARD - 20070702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Complex Regional Pain Syndrome	8799-8720	20%	Reflex Sympathetic Dystrophy, Left Foot	8599-8520	40%	20070320	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Complex Regional Pain Syndrome (CRPS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the left foot pain began after the CI twisted his left ankle while running in December 2006.  The informal PEB placed the CI on the TDRL effective 24 March 2007 for reflex sympathetic dystrophy (RSD), left foot and ankle, rated 40%, coded 8799-8720 (analogous to neuritis of the sciatic nerve), citing moderately severe incomplete paralysis.  
At the 20 March 2007 VA Compensation and Pension (C&P) evaluation, 15 months before TDRL removal, the CI reported constant burning pain to his left foot.  The examiner noted hyperreflexia, muscle atrophy, hypersensitivity to touch, pinprick and vibration, and a waxy appearance to the left foot.  At the 9 April 2008 orthopedic consult examination, 2 months prior to separation from TDRL, the CI reported continued pain that limited his activities.  The examiner noted an antalgic gait. The examination showed the left foot having a normal appearance, hypersensitivity, paresthesias to touch but no swelling.  The 10 April 2008 TDRL NARSUM, 2 month prior to separation, recommended the case be referred to the PEB for further adjudication since the CI did not meet Army retention standards.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the CRPS 20%, coded 8799-8720, citing a normal gait, skin color, perfusion and skin texture with some tenderness and pain limiting motion and rated the condition 20% as equivalent to moderate incomplete paralysis, the maximum allowed under VASRD paragraph 4.124.  The VA rated RSD of the left foot 40%, coded 8599-8520, (analogous to paralysis of the sciatic nerve) based on the C&P examination 15 months before TDRL removal, citing “incomplete paralysis below the knee which is moderately severe.”  At the time the CI was removed from TDRL, he was experiencing intermittent pain, no loss of reflexes, no muscle atrophy, and some sensory disturbance.  This clinical presentation is more consistent with neuralgia rather than neuritis.  Considering VASRD §4.123 (neuralgia, cranial or peripheral) the condition is rated with a maximum equal to moderate incomplete paralysis for the sciatic nerve, which is 20%.  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 left foot at the time of TDRL removal.  

BOARD FINDINGS:  In the matter of the left foot condition and IAW VASRD §4.123a, the panel unanimously recommends no change in the PEB adjudication at the time of TDRL removal.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005700, 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