RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03642
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070619

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multiple Launch Rocket System Fire Direction Specialist, medically separated for “reflex sympathetic dystrophy with right ankle pain” with a disability rating of 20%.   

CI CONTENTION:  His knee and ankle conditions continue to worsen.  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 - 20070406	VARD - 20070809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Reflex Sympathetic Dystrophy with Right Ankle Pain	8799-8720	20%	Status Post Right Ankle Sprain with Residual Pain	5271	20%	20070417	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy with Right Ankle Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was injured in April 2006 during a four-wheeling accident.  Right lower extremity X-rays in May 2006 were interpreted as normal by radiology and orthopedics, but an MRI revealed a partial tear of the anterior talo-fibular ligament.  Due to the nature of his pain, the CI was thought to be in the early stages of reflex sympathetic dystrophy.  

During the 15 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed decreased range of motion (ROM) and strength.  At the MEB NARSUM examination the next day, the CI complained of right ankle pain that interfered with his ability to accomplish necessary military specialty duties.  Physical examination revealed an antalgic gait without use of an assistive device, and an ability to stand, but not walk, on toes and heels due to pain.  However, the provider noted that he performed “daily functional transitions without difficulty.”  Anterior drawer and valgus and varus stress test were negative.  Bilateral lower extremity strength was normal and sensation was intact to light touch.   Right ankle ROM following repetition showed dorsiflexion of 5 degrees (normal 20) and plantar flexion of 20 degrees (normal 45), with pain during all measurements.  

At the 17 April 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant sharp pain, rated at 8/10, which traveled into his foot and could be elicited by physical activity.  The examiner noted an antalgic gait with arch supports required for ambulation.  There was painful motion and tenderness with right ankle dorsiflexion to 3 degrees and plantar flexion to 28 degrees, and a loss of 2 degrees due to repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the reflex sympathetic dystrophy with right ankle pain condition 20%, coded analogously to 8720 (sciatic nerve, neuralgia), citing moderate incomplete paralysis.  The VA also rated the right ankle condition 20%, coded 5271 (limited motion of the ankle), based on the C&P examination, citing limited ROM.  Members noted that the VA assigned the maximum rating available under the diagnostic code 5271, and that there was no ankylosis, nonunion or malunion to warrant a rating higher.  Using code 8720, the next higher rating is for “moderately severe incomplete paralysis.”  While the NARSUM noted the CI had an antalgic gait, he had normal strength and was able to perform daily activities.  The panel agreed the disability picture more nearly approximated a moderate incomplete paralysis and not the moderately severe level.  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 reflex sympathetic dystrophy with right ankle pain.  

BOARD FINDINGS:  In the matter of the reflex sympathetic dystrophy with right ankle pain condition and IAW VASRD §4.124, 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010018, 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