RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
 
BRANCH OF SERVICE:  ARMY 
NAME:  XXXXXXXXXXXXX                                
   
CASE NUMBER:  PD1200285                                      
  DATE OF PLACEMENT ON TDRL:  20000531 
BOARD DATE:  20121012                                          DATE OF PERMANENT SEPARATION:  20050616 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  Army  SPC/E-4  (54B10/NBC  Specialist),  medically 
separated for vocal cord dysfunction (VCD) and complex regional pain syndrome (CRPS) of the 
right  lower  extremity.    The  CI  suffered  a  right  foot  injury  and  despite  treatment  developed 
chronic right foot pain.  During the same time period, she experienced intermittent shortness of 
breath and voice changes that ultimately was diagnosed as vocal cord dysfunction.  These two 
conditions did not improve adequately with treatment  to meet the physical requirements of 
her  Military  Occupational  Specialty  or  satisfy  physical  fitness  standards.    She  was  issued  a 
permanent  L3,  P3  profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB 
forwarded  vocal  cord  dysfunction  as  the  only  condition  for  Physical  Evaluation  Board  (PEB) 
adjudication.  The PEB included right lower extremity CRPS condition with the MEB’s vocal cord 
dysfunction  and  designated  them  both  as  unfitting,  and  not  sufficiently  stable  for  final 
adjudication.  The CI was placed on the Temporary Disability Retired List (TDRL) with the ratings 
charted below.  On final PEB evaluation, 62 months later, the PEB adjudicated the vocal cord 
dysfunction and right lower extremity complex regional pain syndrome as unfitting, rated at 0% 
and 10% respectively, with application of the Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD).  The CI did not concur with the PEB findings, waived a formal hearing, but submitted a 
written appeal.  The US Army Physical Disability Agency (USAPDA) reviewed the entire case and 
concluded that it was properly adjudicated and made an administrative change in the code for 
the CRPS condition.  The CI was medically separated with a 10% disability rating. 
 
 
CI CONTENTION:  “The severity of the service connected disabilities.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all cases.  The remaining conditions rated by the VA at separation and listed on the DD Form 
294  application  are  not  within  the  Board’s  purview.    Any  conditions  or  contention  not 
requested in this application, or otherwise outside the Board’s defined scope of review, remain 
eligible for future consideration by the Army Board for Correction of Military Records. 
 
 
 
 
 
 

 
 
 
TDRL RATING COMPARISON: 
 

Service PEB Admin Correction – Dated 20050616 
Rating 

Condition 

Code 

Complex Regional Pain 
Syndrome, Right Lower 
Extremity 
Vocal Cord Dysfunction 

5299-5003 
8799-8725 
6599-6520 

TDRL 
20% 

Sep. 

- 

- 

10% 

10% 
0% 

No Additional MEB/PEB Entries 

Combined:  10% 

VA* – All Effective Date 20000531 
Rating 

Code 

Condition 

5299-5278 

Chronic Regional Pain 
Syndrome, Right Foot 
Vocal Cord Dysfunction 
Reactive Airway Disease 
Tendonitis, Left Wrist 
Tendonitis, Right Wrist 

6599-6516 
6699-6602 
5099-5020 
5099-5020 
Not Service Connected x 3 

Combined:  40%* 

20% 

0% 
10% 
10% 
10% 

Exam 

19990809 

19990809 
19990809 
19990809 
19990809 
19990809 

* Hypertension, 7101, rated 10% effective 20060726; remainder of ratings unchanged with 5 NSC conditions (combined 50%)  
 
 
ANALYSIS  SUMMARY:    The  Board  notes  the  current  VA  ratings  listed  by  the  CI  for  all  of  her 
service-connected conditions, but must emphasize that its recommendations are premised on 
severity at the time of separation.  The VA ratings which it considers in that regard are those 
rendered most proximate to separation.  The Disability Evaluation System (DES) has neither the 
role  nor  the  authority  to  compensate  members  for  anticipated  future  severity  or  potential 
complications of conditions resulting in medical separation.  That role and authority is granted 
by Congress to the Department of Veterans’ Affairs (DVA).  The Board’s operative instruction, 
DoDI 6040.44, specifies a 12-month interval for special consideration to DVA findings.  This does 
not mean that the later DVA evidence was disregarded, but the Board’s recommendations are 
directed to the severity and fitness implications of conditions at the time of separation.  In this 
circumstance, therefore, the evidence from the record is assigned significantly more probative 
value as a basis for the Board’s recommendations. 
 
Bilateral True Vocal Cord Dysfunction Condition.  The narrative summary (NARSUM) prepared 3 
months prior to TDRL adjudication notes history of shortness of breath beginning in March of 
1998 initially noted at night and when around smoke in her workplace.  She was evaluated with 
pulmonary  function  tests  (PFTs)  and  then  treated  with  bronchodilators.    Her  symptoms 
continued  and  over  a  period  of  a  year  inhaled  corticosteroids  were  added  along  with  three 
short  courses  of  oral  steroids.    The  CI  had  a  negative  Methacholine  challenge  test.    Her 
breathing complaints persisted and in spite of treatment, her PFTs remained about the same.  
Also during that period, the CI developed voice problems and began evaluation and treatment 
by local speech pathologists.  After evaluation by ENT and pulmonary services, the CI was given 
the diagnosis of vocal cord dysfunction and MEB was initiated.  Examination revealed “…one 
slight  wheeze  in  her  base  with  rapid  expirations;  otherwise,  the  chest  seemed  clear.    The 
wheeze seemed to be coming from the neck area, which would be expected with vocal cord 
dysfunction syndrome.”   
 
At the  MEB  exam, the CI  reported  “RAD  (reactive  airway  disease),  VCD  cause  me to be  very 
sensitive to getting sick easily” and “they all cause me to have shortness of breath at times.”  
The MEB lung and chest exam noted “clear with normal respiration, but upper airway strider 

with forced expirations.”  The MEB identified the vocal cord dysfunction condition and referred 
the package for PEB adjudication.   
 
At the VA Compensation and Pension (C&P) exam performed 6 months prior to initial entry into 
TDRL status, the CI reported difficulty breathing, wheezing and dyspnea on exertion after being 
exposed to chemicals around January 1998.  She also had a voice disorder with hoarseness and 
low-pitched  voice.    She  was  evaluated  by  a  pulmonary  consultant  and  was  told  she  had 
“bronchial asthma” for one year.  She also had a + PPD in November 1998 (as did her husband) 
with  the  CI  and  her  family  treated  with  INH  prophylaxis.    She  had  normal  chest  X-rays.  
Medications include inhaled bronchodilators and steroids as well as intermittent courses of oral 
steroids.  Physical examination revealed clear lungs bilaterally.  Direct visualization of the cords 
was reported as normal.   
 
The final TDRL-reevaluation indicated the CI was taking daily inhaled medications (Flovent, with 
episodic Albuterol), and complained of episodic shortness of breath.  Exam indicated clear chest 
without wheezing and “erythema of the posterior nasopharyngeal wall as the posterior glottis, 
and the posterior true vocal cords.  There is symmetric motion of the vocal cords and there is 
no paradoxical motion noted.”  There was no mention of speech volume or clarity; however, 
the  CI  was  referred  to  Speech  Therapy.    Two  examinations  with  PFT  data  proximate  to 
separation demonstrated “Normal Spirometry.  No change with bronchodilators.”  FEV-1’s were 
88%  and  75%  (Forced  Expiratory  Volume  in  one  second),  and  there  was  no  mention  of 
abnormal  flow  loops.    Medication  profile  did  not  indicate  dispensing  of  Flovent  or  Albuterol 
from the military treatment facility, but both medications were listed as being used. 
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.  
Entering  into  the  TDRL  period,  the  CI’s  VCD  was  coded  analogously  as  6599-6520  (Larynx, 
stenosis)  and  rated  10%  with  a  stated  “FEV-1  86%.”    At  final  PEB  adjudication,  the  VCD  was 
rated  at  0%  using  a  stated  “FEV-1  82%.”    The  source  PFT  exam  was  not  in  the  evidence  of 
record.  The VCD condition is not a bronchospastic/asthma related condition, but does use PFT 
data  for  rating  purposes  IAW  §4.97  Schedule  of  Ratings—Respiratory  System.    The  PFT 
evaluation performed one month prior to separation is deemed the most probative exam.  That 
exam documents a post bronchodilator FEV-1 of 75%.  Using VASRD code 6520, the same code 
utilized  by  the  PEB,  a  FEV-1  of  75%  is  rated  at  10%.    A  30%  rating  would  require  a  FEV-1 
between  56%  and  70%  with  an  abnormal  flow-volume  loop.    The  CI  never  demonstrated 
reversible  bronchospasm,  especially  prior  to  daily  inhaled  anti-inflammatory  medication  use, 
she  had  a  negative  Methacholine  challenge  test,  and  pulmonary  specialist  at  interim  TDRL 
evaluation  indicated  “this  is  not  asthma”;  making  reversible  bronchospasm  unlikely  as  the 
etiology  of  her  breathing  complaints.    Using  an  alternative  coding/rating  schemes  related  to 
asthma (or other “bronchospastic” conditions) is not appropriate in the case, as asthma was not 
an unfitting condition.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board recommends a disability rating of 10% for the VCD condition at entry into 
TDRL and at separation.   
 
Complex  Regional  Pain  Syndrome,  Right  Lower  Extremity  Condition.    Review  of  service 
treatment records (STR) reveals chronic right foot pain since foot trauma in mid 1998 with over 
34  medical  encounters  in  the 20  month  period prior to  the  PEB.    The  vast  majority  of these 
visits  were  for  pain  related  issues  and  there  were  no  documented  limitations  of  range-of-
motion (ROM) or weakness issues identified.  Neurology evaluation documented no swelling, 
no  weakness,  no  atrophy  and  normal  deep  tendon  reflexes  with  pain  “essentially  from  the 

distal anterior 1/3 of foot 1st > 5th but all involved.”  Sensory changes to vibration and light 
touch were documented.  After complete evaluation, the CI was given the diagnosis of CRPS, 
Type I.   
 
The NARSUM prepared a month prior to the CI’s final TDRL review, notes an injury of the right 
foot  while  marching  at  night  in  May  of  1998.    Injury  was  initially  treated  with  6  weeks  of 
immobilization for what was thought to be a fracture but later determined to be a contusion.  
The  CI  began  experiencing  severe  right  foot/ankle  pain  and  was  diagnosed  with  reflex 
sympathetic dystrophy after a completely normal evaluation that included magnetic resonance 
imaging  (MRI),  bone  scan  and  neurologic  evaluation.    She  was  treated  by  pain  management 
specialist, physical and occupational therapy utilizing numerous medications, sympathetic block 
and  epidural  steroid  injections  without  relief.    Physical  examination  revealed  painful  gait 
favoring right leg with light touch producing increased uncomfortable sensation.  The foot had 
full active and passive ROM and stable ligaments.  Sensation was intact throughout her entire 
lower extremity, although there was a slight decrease in sensation to light touch in the distal 
leg.  “The service member continues to state that her foot is in constant moderate pain, it is a 
throbbing  type  of  pain  which  changes  occasionally  to  an  achy  type  of  pain  in  the  foot  with 
weather changes or if it is cold outside.  Overall she believes that her condition is stable, is not 
getting any worse, but certainly not getting any better.”   
 
At  the  C&P  exam  the  CI  reported  that  in  May  1998  while  training  at  the  National  Training 
Center,  she  injured  her  right  foot  when  “it  fell  in-between  the  rocks.”    She  experienced 
significant pain and swelling and X-rays were negative for fracture.  She was immobilized for 2 
months  but  continued  to  experience  chronic  daily  pain  of  moderate  to  severe  degree.    She 
underwent  two  lumber  blocks.    She  had  an  extensive  evaluation  and  well  documented  right 
foot pain, weakness and numbness with a diagnosis of  chronic regional pain syndrome.  She 
reported  tingling  on  the  lateral  aspect  and  hyperesthesia  of  the  right  foot.    Examination 
revealed use of a walker with CI holding her foot in an everted position.  Exam was limited due 
to pain but seemed to have decreased muscle strength right foot/ankle.  Normal deep tendon 
reflexes.   
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.  
Entering into the TDRL period, the CI’s CRPS was coded analogously as 5299-5003 and rated 
20% with application of the USAPDA Pain Policy for moderate constant pain.  At the CI’s TDRL 
re-evaluation 62 months later, the PEB utilized VASRD-only rules for the final adjudication of 
the  CRPS  condition  with  an  analogous  code  of  8799-8725  (Neuralgia,  Posterior  tibial  nerve; 
[tarsal tunnel]) and rated 10% for mild incomplete neuralgia of the lower extremity.  For rating 
at TDRL entry, VASRD-only rating would be at most 20% for 8799-8525, (severe) as there was 
documented  weakness  and  pain,  and  conceding  the  severe  level.    At  TDRL  separation, 
alternative coding under VASRD code 8525 (Paralysis) is not applicable as there was no motor 
weakness documented.  Analogous rating under 8725 (Neuralgia) requires adherence to VASRD 
§4.124:  “When the involvement is wholly sensory, the rating should be for the mild, or at most, 
the moderate degree.”  Rating as “moderate” due to antalgic gait would result in a rating of 
10% and provide no benefit to the CI (“Mild” and “Moderate” each rate 10% under 8725).  After 
due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), 
the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication  for  the  complex  regional  pain  syndrome  condition  on  TDRL  entry  or permanent 
separation. 
 
 

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise from the record that any prerogatives outside the VASRD were exercised in the PEB’s 
final adjudication exiting the TDRL period.  In the matter of the bilateral true VCD condition, the 
Board unanimously recommends a disability rating of 10%, coded 6599-6520 IAW VASRD §4.97.  
In the matter of the CRPS condition, the Board unanimously recommends no change in the PEB 
adjudication.    There  were  no  other  conditions  within  the  Board’s  scope  of  review  for 
consideration. 
 
 
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of her prior medical separation: 
 

RATING 

TDRL  PERMANENT 
10% 
20% 

10% 

- 

VASRD CODE 
6599-6520 
5299-5003 
8799-8725 
COMBINED 

- 

30% 

10% 
20% 

UNFITTING CONDITION 

Bilateral True Vocal Cord Dysfunction 
Complex Regional Pain Syndrome 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120311, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20120020636 (PD201200285) 
 
 
1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review 
(DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  
Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s 
recommendation to modify the individual’s disability rating to 20% without recharacterization 
of the individual’s separation.  This decision is final.   
 
2.  I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum.    
 
3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)