RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05273
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Water Treatment Specialist, medically separated for “benign fasciculation syndrome” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 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 - 20080125	VARD - 20090105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
BFS	8199-8103	10%	Benign Fascicular Cramping Syndrome, Affecting the Right Lower Extremity	8010-8260	10%	20080626	
			Benign Fascicular Cramping Syndrome, Affecting the Thoracolumbar Spine	8010-5237	10%	20080626	
			Benign Fascicular Cramping Syndrome, Affecting the Cervical Spine	8010-5237	10%	20080626	
			Benign Fascicular Cramping Syndrome, Affecting the Left Lower Extremity	8010-8260	20%	20080626	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Benign Fasciculation Syndrome (BFS).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s BFS began in March 2007 when he developed cramping, pain, and weakness in his left hand and leg.  Thorough evaluation by neurology, rheumatology, and a neuromuscular specialist did not identify an etiology for his symptoms.  The CI reported a family history of amyotrophic lateral sclerosis (ALS) in his father, however, genetic testing for familial ALS was negative.  The CI was diagnosed with BFS and symptomatic treatment was recommended.  At serial neurological examinations between June and August 2007, physical examination showed a “slight limping to the left due to weakness.”  Examination of cognitive function, cranial nerves, and complex motor functions was normal.  Muscle tone was increased affecting the legs more than the arms.  Strength was normal in the upper extremities and right lower extremity.  The left lower extremity strength was graded 4+/5; give-away and weakness were noted with hip flexion, knee extension, and ankle dorsiflexion.  Sensation to light touch/pinprick was reduced in the left hand, leg, and left side of the trunk.  

During the 6 November 2007 MEB physical examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, “minimal” left arm and left leg weakness was recorded.  The CI walked with a cane on the left.  At the 14 December 2007 MEB NARSUM examination the CI reported primarily back pain secondary to cramping and use of a cane secondary to “some loss of strength” in his left leg.  Physical examination cited the DD Form 2808 and neurology examinations in the STR as summarized above.  

At the 26 June 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported cramping with intermittent left leg pain and weakness and intermittent pain and spasm of his back and arms.  He reported left leg and bilateral forearm muscular symptoms were constant every day and without flares and spinal pain and spasms were every other day.  He walked with a cane as prescribed by the neurologist in case of sudden left leg weakness.  Physical examination noted a normal gait.  There was no spinal muscle spasm, tenderness or guarding.  There was pain with full thoracolumbar flexion and with full cervical flexion and extension.  Upper and lower extremity muscle strength was normal bilaterally, except for left hip strength, graded 4/5.  There was decreased vibration of the great toes and decreased sensation to sharp and dull in all distributions of the left leg and foot.  Reflexes were normal throughout.  Electrodiagnostic studies performed in August 2008 were normal with no evidence of radiculopathy, polyneuropathy, and no fasciculation potentials noted.  Examination of the right and left feet and the right and left hands was normal, without impaired strength noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the BFS 10%, analogously coded as 8103 (convulsive tic), citing the condition as moderate.  The VA rated the BFS based on residuals – left leg 20%, dual coded 8010-8620 (myelitis-sciatic neuritis moderate neuritis); right leg 10%, dual coded 8010-8620 for mild neuritis; cervical spine 10%, coded 8010-5237 (myelitis-cervical strain) for painful motion and thoracolumbar spine 10% coded 8010-5237 (myelitis-lumbosacral strain) for painful motion, all based on the C&P examination.  There is no specific VASRD code for BFS and IAW VASRD §4.20 (analogous ratings) it is permissible to rate the condition under a closely related code that is a good fit for the CI’s disability.  The panel considered analogous VASRD nerve and muscle codes and member consensus was 8103 was the most appropriate code based on the CI symptoms and medical evidence in record.  A 10% rating was supported for moderate convulsive tic, coded 8199-8103 based on the MEB NARSUM and VA examinations and supported by examinations in the STR.  The panel agreed the CI’s BFS condition could not be characterized as severe for higher rating based on the limited abnormal findings at the VA examination (the most proximate examination to separation) which included a normal gait.  

BOARD FINDINGS:  In the matter of the benign fasciculation syndrome 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.  

PD-2017-05273

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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

PD-2017-05273