[AR Number], XXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXXX .
XXXXXXXXXXXXXXXXX,  
XXXXXXXXXXXXXXXXX

Dear  XXXXX:

	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.
 
	A copy of this decision has been provided to the counsel you listed on your application; [name and address].

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX.  	CASE:  PD-2017-04604
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “chronic left posterior thigh pain due to shrapnel wound” with a disability rating of 20%. 

CI CONTENTION:  Review requested of additional conditions (PTSD and sleep apnea) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080716	VARD - 20090224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Posterior Thigh Pain…	8799-8720	20%	Left Thigh Pain … Retained Shrapnel	5315	10%	20080910	
			Shrapnel Wound, Scar, Left  Posterior Thigh	7804	10%	20080910	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Posterior Thigh Pain.  According to the service treatment (STR) record and MEB narrative summary (NARSUM), the CI sustained a shrapnel injury on 30 April 2006 with a single penetrating fragment to the posteromedial upper thigh.  An X-ray identified a 6 x 3-mm fragment located in “the soft tissues medial to the left mid femoral shaft,” but no joint, bone, or vascular involvement.  There was concurrence by several surgeons (including VA) that surgical removal was not indicated.  
Clinical entries in the STR recorded persistent upper posterior thigh pain, with intermittent sensory symptoms, that did not adequately respond to treatment.  There was ample documentation of normal neurological findings, demonstrated full strength, intact sensation, normal reflexes, and normal gait and coordination.  There was no indication of deterioration with fatigue or note of any joint injury or range of motion (ROM) limitation.

The 11 June 2008 MEB NARSUM examination, 3 months prior to separation, recorded chronic pain, rated at 5-6/10, that limited excessive walking and prohibited running and multiple general soldiering requirements (profile permitted walking and running at own pace).  The physical examination recorded a healed, moderately tender, 1.5 cm wound of the left thigh.  There was no note of abnormal muscle or neurological (motor, sensory and reflexes) findings.

The 10 September 2008 VA Compensation and Pension (C&P) examination, on the eve of separation, documented nonspecific pain that limited standing to 15-20 minutes and prohibited running or heavy lifting.   The physical examination recorded a mildly tender and moderately adherent 3.8 X 1.8 cm scar (left posteromedial thigh) that specifically did “not impede movement of hip or knee.”  There was no muscle atrophy or tissue loss, and detailed neurological findings were normal, to include gait, balance, strength, sensation, proprioception, and coordination.  There was no note of increased fatigability.  
	
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left thigh condition 20%, coded 8799-8720 (analogous to sciatic neuralgia), citing the applicable criterion of “moderate” nerve impairment.  The VA rated the left thigh condition 10%, coded 5315 (group XIII muscle disability), based on the C&P examination, citing applicable “moderate” criterion; and, provided an additional 10% rating under code 7804 (scars, unstable or painful) for “one or two scars that are unstable or painful.”

The panel first agreed that additional rating for the scar was not justified since there was no evidence of the requisite functional link to fitness for rating (well corroborated by the C&P findings).  There also was no evidence to support a diagnosis, or ratable criteria, for alternative rating under any VASRD §4.71a code as noted above.  Therefore the only VASRD options for rating were analogous to nerve impairment under §4.124a (as per the PEB) or under a §4.73 muscle disability code (as per the VA).  The PEB’s coding choice was applicable and the most favorable for nerve rating and the VA’s coding was clinically accurate for rating muscle disability.  The panel first deliberated whether the next higher 40% rating for “moderately severe” nerve impairment under code 8799-8720 was justified, and agreed it was not since general mobility and routine activities were unaffected, and there was no evidence for any objective neurologic deficits.  Panel members next considered whether the next higher 30% rating was justified for “moderately severe” muscle disability under code 5315.  Rating of muscle disabilities relies significantly on cardinal signs and symptoms which §4.56 defines as “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, [and] impairment of coordination and uncertainty of movement.”  The moderately severe rating requires a “consistent complaint of cardinal signs and symptoms,” and the panel agreed that, in general, none of the cardinal signs were clearly in evidence, although the possibility of lowered threshold of fatigue or fatigue-pain could not be confidently excluded.  The latter, however, are more specifically referenced in the §4.56 criteria for a moderate rating.  Thus, members agreed that the evidence was much better aligned with the moderate rather than with the moderately severe criteria, and therefore concluded that the evidence did not justify a more favorable coding or rating option than that of the PEB.  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 left thigh condition.

BOARD FINDINGS:  In the matter of the chronic left posterior thigh pain 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: