RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00004
BRANCH OF SERVICE:  Army 	BOARD DATE:  20151016
SEPARATION DATE:  20060218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Shower, Laundry, and Clothing) medically separated for right leg pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right leg pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his leg pain as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Diagnosed with chronic pain syndrome.  Original injury from knee down now progressed from back, hip, butt, thigh, knee, nerve problems.  Skin is sensitive to point of crying and severe pain due to original injury that has increasingly progressed through the years from shots to block nerve, and several medications, Gabapentin, Neurontin, Valium, Cymbalta, Ibuprofen, with no progress.  Doctors diagnosed me with chronic pain syndrome due to original injury that I received on active duty.”  The CI’s complete submission is at exhibit A.

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. 

RATING COMPARISON:  

IPEB – Dated 20060105	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Leg Pain	5399-5310	10%	Compartment Syndrome, Right Leg 	5299-5262	10%	20060420	
			Post Traumatic Cutaneous Neuritis, Right Leg 	8621	10%	20060420	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060525 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY:  

Right Leg Pain.  In October 2004, this CI started having right leg pain.  He was running a great deal, but there was no other trauma or injury associated with the onset of leg pain.  After pressure testing, he was diagnosed with exercise-induced compartment syndrome of the right lower extremity (RLE).  On 8 September 2005, he underwent fasciotomy surgery on the right leg, in an attempt to remedy the compartment syndrome.  After surgery, the CI continued to have problems with his RLE.  He reported paresthesia and pain in the right leg.  Due to the chronic, persistent nature of his RLE symptoms, an MEB was initiated.  The MEB physical examination (PE) was on 6 December 2005.  The CI reported that he was unable to stand greater than 15 minutes, and unable to walk greater than a .25 mile.  The intensity of his RLE pain was 4/10.  On PE, the surgical incisions were well-healed.  There was tenderness to palpation (TTP) of the right calf.  The RLE was hypersensitive to light touch from the knee to the toes.  Muscle strength was within normal limits.  The MEB narrative summary (NARSUM) diagnosis was: “Right leg pain.”  

The CI was medically separated from service on 18 February 2006.  In April 2006, 2 months later, he had a VA Compensation and Pension (C&P) exam.  He reported that he continued to have pain and sensory problems with the RLE.  He was limited in his ability to walk, or to stand for prolonged periods.  On physical examination (PE) of the RLE, there was TTP.  Palpation of the surgical scar area on the lateral right calf caused a “burning feeling.”  There was no soft tissue swelling about the foot or ankle, and distal pulses were normal.  Range-of-motion (ROM) of the right knee was normal.  ROM testing of the right ankle revealed 10 degrees of dorsiflexion, and 45 degrees of plantar flexion.  The CI was asked to do repetitive toe stands.  After 30 seconds he had to stop because of pain.  When he walked back and forth across the room, he had to stop after a minute because of pain.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding options for the chronic right leg pain, but both assigned a 10% disability rating.  The PEB used VASRD code 5399-5310 (analogous to muscle injury).  The VA used VASRD code 5299-5262 (analogous to malunion of tibia and fibula).  The Board determined that the April 2006 C&P exam was just 2 months after separation and therefore had significant probative value.  At that exam, there was no soft tissue swelling about the foot or ankle, and distal pulses were normal.  When asked to do repetitive toe stands, he had to stop because of pain.  When he walked back and forth across the room, he had to stop because of pain.  IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss) and §4.59 (Painful motion), when part of the musculoskeletal system becomes painful with use it must be considered disabled.  A disability rating of 10% is warranted when there is satisfactory evidence of functional loss and functional impairment due to pain. The Board determined that a separation disability rating of 10% was appropriate.  

The Board tried to find a path to a higher rating.  The Board considered using other diagnostic codes which could be applied to the CI’s condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a seriously disabling leg condition or musculoskeletal abnormality which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the chronic right leg pain.  

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 chronic right leg pain, and IAW VASRD §4.10, §4.40, and §4.59; 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 20131218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20150018760 (PD201400004)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA