RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03155
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Integrated Avionics Systems Journeyman, medically separated for “chronic leg pain with recurrent cellulitis” and “mood disorder,” rated 10% each with a combined disability rating of 20%.  

CI CONTENTION:  “I have continued to have a level of pain from ache to severe every day.  I have developed nerve complications to my upper right thigh.  I have constant swelling of right foot.  This has caused me to be depressed and increase in anxiety.  I received pain medicine regularly until I went to a Dr. at the Indianapolis VA.  After this visit I didn’t receive help with pain and went to other sources which I developed issues.  I have been in treatment for addiction since. I am rated at 70% through the VA.” [Sic]  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 - 20050713	VARD - 20061011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic [Right] Leg Pain with Recurrent Cellulitis 	5399-5311	10%	Chronic Right Leg Pain with Recurrent Cellulitis 	5399-5311	0%	STR	
Mood Disorder	9435	10%	Major Depressive Disorder	9434	30%	20060706	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Leg Pain with Recurrent Cellulitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right leg condition began in June 2002 after developing an abscess on his right ankle that spread into his right leg.  He underwent surgical incision and drainage with open healing and skin grafts in November 2002.  He was subsequently hospitalized for ongoing wound care.  Despite aggressive therapeutic measures, the CI still had recurrent right leg swelling, pain and episodes of cellulitis.  The 8 June 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of right leg pain.  The physical examination (PE) noted “full range of motion (ROM) throughout.”  There was no right leg swelling and peripheral sensation was intact.  A surgical scar was described as “healed” extending from the right ankle to the inner and upper portion of the right thigh.  A clinical encounter on 3 October 2005 (the same day of separation) documented an episode of right leg cellulitis for which the CI was prescribed an antibiotic on an outpatient basis.  Eight days later, on a follow-up phone consultation, the documentation noted that according to the CI’s spouse, “The [CI was] feeling much better and the leg look[ed] much better.”   There was no applicable VA examination in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition 10%, analogously coded 5399-5311 (foot and leg, muscle Group XI function).  The VA rated the right leg condition 0%, also coded 5399-5311, based on the STR, citing a non-compensable rating.  Panel members first considered the PEB’s rating scheme and agreed that since the CI’s actual function of the right lower extremity was not impaired to any significant degree, and that there exists no VASRD code for the diagnosed bacterial cellulitic condition, it was appropriate to rate according to VASRD code 7820 (infections of the skin not listed elsewhere [including bacterial, fungal, viral, treponemal and parasitic diseases]): Rate as disfigurement of scars (7801, 7802, 7803, 7804, or 7805) or dermatitis (7806), depending upon the predominant disability.  Panel members agreed that an analogous 7806 code was appropriate, absent the scar being non-linear, from a burn or being unstable.  The percent rating under this coding scheme is based upon the percent of body involvement and or medication therapy used during the last 12 months.  Although the CI had a significant linear scar, neither criteria of percent body involvement or medication use in the previous year was supported for the minimum positive impairment rating.  Therefore, the condition would support no greater than a 0% rating.  However, IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  Therefore, after considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that was insufficient cause to recommend a change in the PEB’s adjudication for the chronic right leg pain with recurrent cellulitis.   

Mood Disorder.  According to the STR and MEB NARSUM, the CI’s mood disorder began in February 2003 after an alcohol related event.  On 29 November 2004, the CI was diagnosed with “life circumstance problems”.  On 8 December 2004, the CI was definitively diagnosed with adjustment disorder with depressed mood and later to a mood disorder due to chronic pain with major depressive-like episode.  During the 11 June 2005 MEB mental health (MH) NARSUM examination, 4 months prior to separation, the CI reported tremendous pain relief from pain medication, with marked improvement in mood and sleep.  His mental status examination was unremarkable with the exception of mild psychomotor agitation (tension) only when he experienced pain.  Thought processes were logical and well organized and reveal no looseness of associations or flight of ideas.  He expressed no delusions and denied hallucinations.  Attention, concentration and memory were intact and judgment and insight were fair.  At the 6 July 2006 VA MH examination, 9 months after separation, the CI reported being depressed at times and had intrusive worries every day with frequent irritability.  Additionally, he endorsed occasional non-trauma related nightmares as well as occasional problems concentrating at work.  He denied suicidal thoughts and the psychiatric examination was normal except for a constricted affect and an “exhausted” mood.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mood disorder 10%, coded 9435 (mood disorder, not otherwise specified).  The VA rated the mood disorder 30%, coded 9434 (major depressive disorder), based on the C&P examination, citing the VASRD rating criteria for a 30% rating.  The panel first considered if the provisions of VASRD §4.129 applied to this case (MH condition resulting in medical separation as a result of a highly stressful event.  The panel noted and agreed that the CI’s life stressors although considerable, were not comparable with the §4.129 criterion definition.  All members further agreed that the predominant stressors in this case were mainly related to the CI’s chronic physical condition and therefore, the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not satisfied.  The panel next considered the VASRD §4.130 impairment rating at separation.  All panel members agreed that the pre-separation findings of only “mild agitation” associated with physical pain would not support any MH rating above the PEB’s 10% impairment rating.  Considering the totality of the evidence and mindful of VASRD §4.3, members agreed that a disability rating of 10% for the mood disorder was appropriate in this case. 

BOARD FINDINGS:  In the matter of the right leg condition and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  In the matter of the mood disorder and IAW VASRD §4.130, 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:

SAF/MRB

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Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03155.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.