RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01610
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “reflex sympathetic dystrophy, right ankle” with a disability rating of 20%. 

CI CONTENTION:  “Have had surgeries on both knees.  They are unstable and I am in pain 24/7.  Because my rating is so low, I have to work which has worsened them.”  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 - 20090211	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy, Right Ankle	8699-8622	20%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy, Right Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right ankle surgical correction of instability on 25 July 2008.  The CI did well after surgery, but by September 2008, she began to experience pain with extreme hypersensitivity of the right foot.  There was no further surgical indication.  

The 28 January 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of right ankle pain that limited many activities including requiring her to depress the accelerator and brake with the left foot.  Physical examination showed an antalgic gait and discoloration of the right foot and ankle with exquisite tenderness.  The surgeon noted that weakness was not a significant factor.  The examiner referenced a physical therapy range of motion (ROM) study, which showed dorsiflexion of 5 degrees (normal 20) and plantar flexion to 45 degrees (normal) which were equal to the unaffected left side.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, analogously coded 8699-8622 (neuritis of the musculocutaneous (superficial peroneal) nerve), citing decreased ROM and severe incomplete paralysis of the superficial peroneal nerve.  The panel noted that with the lack of weakness of eversion of the foot, the PEB adjudicated the maximum rating using the appropriate code (8622).  The panel considered alternative VASRD §4.124a and analogous codes, but all were less applicable and not advantageous to the CI for rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007960, 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