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AF | PDBR | CY2013 | PD-2013-01798
Original file (PD-2013-01798.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD- 20 1 3 - 0 1798
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0303
Separation Date: 20051201


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Motor Transport Operator) medically separated for right lower extremity (RLE) pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty . He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The RLE pain condition, characterized as “neuropathic pain in the distribution of the femoral nerve in the R/Lower extremity, proximal to the knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 . The MEB also identified and forwarded two other conditions (weakness in the right quadriceps , not meeting retention standards; and anxiety disorder , meeting retention standards ) for PEB adjudication. The Informal PEB adjudicated right lower extremity pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI did not concur with the PEB; however, no appeal was present in the evidence for review and the CI was medically separated.


CI CONTENTION : The CI elaborated no specific contention in his application.


 SCOPE OF REVIEW : The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited 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 PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


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invalid font number 31502 RATING COMPARISON invalid font number 31502 :

Service Admin PEB – Dated 20051005
 VA - (~ 1 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Lower Extremity Pain 8729 0% Lateral Femoral Cutaneous Neuropathy… Right Thigh 8526 20% 20051108
Scars, Right Thigh… 7804 10% 20051108
Residuals of Shell Fragment Wounds of Left Posterior Thigh/Buttock 5314 10% 20051108
Other x 2 (Not in Scope)
 Other x 10
Combined: 0%
 Combined: 70%
* Derived from VA Rating Decision (VARD) dated 20060714 ; earlier VARD dated 20060605 deferred the condition


ANALYSIS SUMMARY :

Right Lower Extremity Pain Condition . The CI sustained an injury to his thighs when he was struck by multiple shrapnel fragments on 9 April 2004 while in Iraq. His wounds were debrided and he was transferred to the regional medical center for more treatment. The Orthopedist noted three wounds each 1 centimeter in diameter on the proximal right lateral thigh . The CI was referred to PT for strengthening. The PT noted right thigh numbness, pain and heat at night in the thigh and required crutches. There wer e physical exam findings of limited right knee range-of-motion o f 60 degrees. The General Surgeon noted the shrapnel wounds were healing well and a Physical Medicine Specialist documented right anterolateral thigh numbness , sharp pain , and weakness. There were physical exam findings of right thigh mild muscle wasting, allodynia ( pain due to a stimulus that does not usually provoke pain) over the right anterolateral thigh; and hyperesthesia . The examiner diagnosed right lateral femoral cutaneous neuropathic pain and recommended a Lidoderm pain patch ( a medication indicated for nerve pain) with a referral to Pain Management. The PT noted right thigh hypersensitivity and a twisting pain in the right thigh when rising from a chair. There were physical exam findings of right quadriceps muscle atrophy, mild limp and hyperesthesia in the right thigh. The electromyogram (EMG) demonstrated neuropathy of the right lateral femoral cutaneous nerve . The MEB narrative summary (NARSUM) exam approximately 6 months prior to separation documented chronic , marked right thigh burning, stabbing , sharp pain to light touch and other minimal stimuli . The pain was exacerbated with vigorous activity such as marching, low-crawling and negotiating obstacles. There were physical exam findings of a patch of sensitivity and pain to light touch spread diffusely along the right anterolateral thigh; marked allodynia and hyperesthesia; however , strength was full and symmetric in the left leg and his reflexes were normal. There was no atrophy noted. The examiner diagnosed neuropathic pain in the RLE femoral nerve in the right lower extremity, proximal to the knee. The VA Compensation and Pension (C&P) exam approximately 24 days prior to separation documented residual numbness and hypersensitivity in the right anterior thigh. The pertinent physical exam findings were a normal gait and several well healed scars on the right and left thighs with no mention of pain, keloid, or instability . There was no thigh muscle weakness, atrophy, tenderness or painful motion. An Addendum to the VA C&P exam dictated approximately 6 months after separation documented hypersensitivity in the distribution of the right lateral femoral cutaneous nerve.

The Board direct ed attention to its rating recommendation based on the above evidence. The PEB coded the RLE p ain condition as 8729 (Neuralgia, e xternal cutaneous nerve of thigh ) and rated at 0% for “mild or moderate . ” The VA coded the right thigh lateral femoral cutaneous neuropathy condition as 8526 (incomplete paralysis, a nterior crural (femoral) nerve ) and rated at 20% for “m oderate ” based on the Addendum information dated 12 June 2006. The Board initially considered which nerve was the cause of the CI’s right leg pain. The evidence present for review (EMG data, service treatment records, NARSUM and C&P exam) supports that the right lateral femoral cutaneous nerve was the peripheral nerve causing all symptoms. There was no evidence of motor /muscle deficits proximal to separation. Rating under peripheral nerve codes entails a judgment call regarding the severity of incomplete paralysis, especially the mild vs. moderate distinction. A rigid assessment could require 3/5 or worse strength testing to merit the moderate rating. More liberal rating applies any objective motor impairment or atrophy as a threshold for the moderate designation. By precedent, the Board threshold for a “moderate” peripheral nerve rating requires some functionally significant motor and/or sensory impairment. The Board agreed that the CI ’s peripheral nerve injury did not exceed the “moderate” level and that the use of the 8729 cod e (copied below for the reader’s convenience) more closely aligned with the CI’s condition.

External cutaneous nerve of thigh.

8529     Paralysis of:

Severe to complete       10
Mild or moderate         0

8629     Neuritis.

8729     Neuralgia.

Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 0% for the RLE p ain condition was appropriately recommended in this case.


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 or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the RLE p ain condition and IAW VASRD §4.124a, 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, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131024 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
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SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX , AR20150011071 (PD201301798)


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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




 Encl              XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                            (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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