RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00014
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060609

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cavalry Scout, medically separated for “right leg compartment syndrome,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends his conditions continue to worsen and negatively impact his daily activities.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVICE PEB – 20060511	VARD – 20060622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Leg Exercise-Induced Compartment Syndrome…	5399-5312	0%	Residual Of Status Post Right Leg Compartmental
Syndrome With Status Post Right Lateral Compartment
Release	5399-5312	10%	20060601	
			Scar; Residual of Right Leg Compartmental Lateral
Release	7804		20060601	
Anxiety Disorder/PTSD	Not Unfitting	Posttraumatic Stress Disorder	9411	10%	20060601	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Leg Exercise-Induced Compartment Syndrome.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right leg exercise-induced compartment syndrome condition began during 2001 after being kicked during physical training.  As a result he underwent an anterior lateral compartment release (fasciotomy) of his right leg.  Postoperatively, he continued to have intermittent right leg pain that significantly limited his activity including physical training and testing despite physical therapy and modification of his activities.  Magnetic resonance imaging (MRI), ordered for neurologic symptoms and weakness of the right leg in February 2006, demonstrated a subtly increased T2 signal within the soleus muscle of the right lower extremity, which may have been secondary to a prior reported fasciotomy; the study was otherwise normal.  In March 2006 the CI indicated he had a dull ache and small area of constant pain over the lateral distal leg and felt some instability with walking.  Electrodiagnostic studies in March 2006 were normal with no evidence of a right peroneal neuropathy or evidence suggestive of peripheral neuropathy or myopathy.  At a physical medicine examination there was point tenderness to palpation in the area of the exiting superficial peroneal nerve.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated April 2006, 2 months prior to separation, the CI reported that it was hard to walk on his right leg after the fasciotomy.  The examiner noted mild tenderness to palpation of the right lower leg.  On 20 April 2006, the NARSUM examiner noted a 22 cm scar down the lateral aspect of the right leg with mild tenderness to palpation on the distal aspect.  There was no fluctuation or any sign of infection.  The range of motion (ROM) of the right knee was 0 to 140 degrees and it was ligamentously stable.  The right ankle ROM was normal with dorsiflexion to approximately 40 degrees and plantar flexion to approximately 50 degrees.  Sensation was intact as was motor strength of the right leg.  The CI walked with a slight antalgic gait with a decreased stance phase on the right side.  As a result he was unable to complete physical fitness testing or perform his duties as a scout secondary to pain in his right leg.  The NARSUM diagnosis was right leg exercise induced compartment syndrome.  Physical therapy ROM measurements on 1 May 2006 of the right hip, right knee and right ankle were within normal limits.

At the VA Compensation and Pension (C&P) examination on 01 June 2006, performed 8 days before separation, the CI reported  he was kicked while playing soccer, which resulted in severe tightness and swelling of the right leg.  Postoperatively, he could not run more than a mile because of severe spasm and tightness in the right leg.  On examination there was a 22 cm scar on the lateral area of the right leg with mild tenderness to palpation and mild keloid formation along the edges of the scar. There was no evidence of acute swelling, instability or abnormal gait, but there was a very mild manifestation of pain, stiffness and tightness of the leg. He had 4/5 motor reflexes on the right and 5/5 on the left; sensation was normal bilaterally. Inversion, eversion, plantar flexion, and dorsiflexion were normal bilaterally.  The examiner indicated the examination was within acceptable range, but opined that with overuse the CI would probably have mild-to-moderate physical impairment and physical limitation with overuse. 

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5399-5312 code (Group XII. Function of the Foot and Leg) for exercise-induced compartment syndrome, citing slight muscle dysfunction.  The VA assigned a 10% rating also using the analogous 5399-5312 code for residual status post right leg compartmental syndrome with status post right lateral release based on the VA C&P examination 8 days before separation, citing functional loss.  The VA also assigned a 10% rating using the 7804 code (scar(s), unstable or painful) for scar; residual of right leg compartmental lateral release citing painful scar.  Board members discussed whether the CI’s condition at the time of separation rose to a moderate level noting that muscle function and strength of the leg were normal both clinically and electrodiagnostically.  In the absence of painful motion, normal ROMs of the knee (codes 5260 and 5261) and ankle (code 5271) and the lack of tibia and fibula impairment (code 5262) there was no route for a higher rating.  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 right leg exercise-induced compartment syndrome condition.  
Contended PEB Condition:  Anxiety Disorder/PTSD.  The Board’s main charge is to assess the fairness of the PEB’s determination that the anxiety disorder/PTSD condition was not unfitting.    The anxiety disorder/PTSD condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The CI was evaluated on 17 July 2005 for alcohol dependence and PTSD and medication (Remeron (mirtazapine, an antidepressant), Antabuse (disulfiram, to prevent drinking alcohol), and Ambien (zolpidem, a sedative for treatment of insomnia)) was prescribed.  In April 2006 the CI reported he was hospitalized for detoxification and possible PTSD based on deployment in 2003-2004 at which time he saw combat.  Five months prior to the visit he had an increased anxiety, hypervigilance, insomnia, and irritability.  On a mental status examination he demonstrated psychomotor restlessness, hyperactivity, and hyperalertness with a heightened startle reflex.  His attitude was distractible and mood was dysphoric and anxious.  Affect was congruent with mood.  Cognitive functioning was normal and thought processes and content were not impaired.  The CI’s was assessed as having alcohol abuse, anxiety disorder NOS; r/o PTSD and insomnia.  Treatment consisted of citalopram (an antidepressant) and zolpidem.  In a memorandum for the PEB dated 20 April 2006, the CI was found fit for duty IAW AR 40-501 for any and all mental health issues.  However, the CI reported in May 2006 that after a family visit he was shaken up and had more symptoms including insomnia, depression and social withdrawal.  Citalopram was continued and quetiapine (an atypical antipsychotic drug) was added for the insomnia along with psychotherapy.  He noted on a biopsychosocial intake form in June 2006 a history of depression in 1988, 2000, and 2005 with anxiety and sleep impairment in 2005.  

There was no performance-based evidence from the record that the anxiety disorder/PTSD condition significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right leg exercise-induced compartment syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder/PTSD condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160013044 (PD201400014)

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