RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-06121
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20040826

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated from the Temporary Disability Retired List (TDRL) for “history of right (non-dominant arm) reflex sympathetic dystrophy [RSD]” with a disability rating of 20%.

CI CONTENTION: The right arm condition has rendered him unemployable. The CI also requested another condition 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 - 20040802	VARD - 20030828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Right RSD	5799-8713	20%	RSD of the Right Upper Extremity	8513	70%	20030626	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

RSD of the Right Upper Extremity (RUE). According to the service treatment record and the MEB narrative summary (NARSUM), the left-handed CI’s RSD began in October 2001 after testing for tuberculosis. There was an injury related to the needle, which resulted in swelling and discoloration of the RUE. The CI was separated and placed on TDRL on 26 October 2002. At the 26 June 2003 VA Compensation and Pension (C&P) examination, 14 months before TDRL removal, the CI reported an inability to work due to RUE pain. The neurological examination was normal, but pain was present when touching the skin of the RUE, shoulder and right side of  the

neck. The CI was unable to perform movements with the muscles of the right hand due to skin movement of the RUE. The examiner concluded the CI was unable to work due to the RSD. There was no documentation of muscle atrophy or sensory changes in the RUE. The 21 January 2004 TDRL MEB NARSUM examination, 7 months prior to separation, noted complaints of pain in the RUE that tended to be exacerbated by cold weather. The CI reported that he was not using his RUE for anything except therapy, which he did himself at home. On examination, his right arm and hand appeared slightly larger than the left and was slightly cyanotic (bluish discoloration of the skin). Reportedly, the CI refused to voluntarily move the RUE and refused further examination. The 14 June 2004 MEB addendum, 2 months before separation, noted the size discrepancy of the right versus the left arm could not be fully evaluated since the CI refused to allow touching of his RUE. The examiner also stated that the CI was capable of moving his arm voluntarily but avoided it due to the onset of pain with movement. The examiner indicated there was some suspicion of symptom magnification.

The panel directed attention to its rating recommendation based on the above evidence. The PEB removed the CI from the TDRL for RUE RSD with a permanent disability disposition of separation with severance pay at 20%, coded analogously 8799-8713 (mild incomplete paralysis of all radicular groups), citing, “The Soldier reports the inability to use the arm. However, the Soldier at the same time reports doing occupational instructed home exercises.” The VA rated the RSD 70%, coded 8513 (paralysis of: all radicular groups), based on the C&P examination, citing severe incomplete paralysis involving the radicular muscles.

Panel members noted no warmth, atrophy or documented changes in skin color during the C&P and NARSUM examinations. Although the CI reportedly was unable to work due to his condition, evidence of muscle or nerve damage was absent. Pain was the only limiting factor. Although pain was present during each examination, reflexes were normal during the C&P examination and there were no paresthesias or hyperesthesias noted on either examination to support a moderate level of impairment. Therefore, a higher rating under 8513 or 8713 is not supported by the records. After due deliberation, considering all 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 RUE RSD at the time of TDRL removal.

BOARD FINDINGS: In the matter of the RUE RSD, 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-2017-06121

XXXXXXXXXXXXXXXX 

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.

PD-2017-06121