RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01771
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “reflex sympathetic dystrophy of the lower right extremity” with a disability rating of 20%.  

CI CONTENTION:  “40% disability rating.  Permanent nerve damage to 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 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 - 20070801	VARD - 20080625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
RSD of the Lower Right Extremity	8799-8721	20%	Right Foot RSD….	5284	10%	20070702	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy (RSD) of the Lower Right Extremity.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot pain began in basic training in August 2006 after a fall from the obstacle course.  Initial X-rays did not reveal evidence of bony abnormality or fracture.  Subsequent MRIs and bone scans noted persistent bony irregularity and increased tracer uptake about the 4th metatarsal bone (top side) of the right foot thus indicating a fracture.  At an orthopedic clinic appointment on 23 January 2007, the CI was additionally diagnosed with RSD.  Despite extensive physical therapy, rehabilitation, and local nerve blocks, her peripheral pain continued and a MEB ensued.  

The 15 February 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic right foot pain aggravated by walking or touching the top aspect of her right foot and ankle.  Physical examination (PE) revealed exquisite tenderness about the right ankle and foot.  There was no joint instability, effusion, or obvious skin changes of the foot.  Sensation, motor activity, and strength of the right lower extremity/foot were normal.  Ankle range of motion (ROM) was 15 degrees dorsiflexion (normal 20) and normal plantar flexion.  

At the 2 July 2007 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported a sharp, burning, achy, and cramping right foot pain that was aggravated by physical activity and relieved by rest or medication.  Her PE revealed a brace about the right foot/ankle.  An antalgic gait was present.  There was tenderness and painful motion.  Edema, disturbed circulation, weakness, and muscular atrophy were all not present.  Right ankle plantar flexion was 40 degrees (normal 45).  Dorsiflexion was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 20%, coded 8721 (neuralgia of the common peroneal nerve), citing moderate, incomplete paralysis.  The VA rated the right foot condition 10%, coded 5284, (other foot injuries), based on the C&P examination, citing moderate limited motion.   

Panel members deliberated the varying coding options presented in this case and concluded that, absent significant ROM deficits or evidence of abnormal bony union, either VASRD primary code used by the PEB (8721) or VA (5284) would be appropriate.  Both codes have impairment levels of 10%, 20%, and 30% with “severe” impairment describing the 30% criteria.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the CI’s overall sensory abnormalities in the presence of near normal ROM did not support any level of “severe” impairment, and therefore the PEB’s 20% rating was appropriate.  Additionally, members agreed that although the PEB’s code indicating neuralgia of the common peroneal nerve was primarily correct, a more precise descriptive code would have been 8521 (incomplete paralysis of the common peroneal nerve) at a moderate (20%) impairment.  This change in the VASRD coding provided no benefit to the CI; therefore, there was insufficient cause to recommend a change in the PEB’s adjudication for the right foot condition.  

BOARD FINDINGS:  In the matter of the right foot 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008174, 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