RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00239
BRANCH OF SERVICE:  Army	BOARD DATE:  20150604
SEPARATION DATE:  20050911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Field Artillery Tactical Data System Operator) medically separated for right leg pain.  The right leg condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic 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 “chronic pain of the right leg secondary to an anterior and lateral compartment fasciotomy for a fascial defect in the right leg” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Why am I getting this? [sic]  I am at 40% right now. What is this all about? [sic]   Right now I am in prison I will give you my house address and the address of the unit I am on.”

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 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:

IPEB – Dated 20050729	VA* - (12 Days. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain of the Right Leg Secondary to an Anterior and Lateral
Compartment Fasciotomy…	5099-5003	0%	Residuals Right Leg Anterior/Lateral Fasciotomy	5399-5311	10%	20050830	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 0	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060110 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Pain of the Right Leg Condition.  The CI was well until he presented in May 2004 for a history of right leg pain while running.  Evaluation determined the cause of symptoms to be elevated pressure within the legs (compartment syndrome) during exertion.  In June 2004 right leg anterior and lateral fasciotomies (surgical compartment releases) were performed.  Symptoms improved post-operatively, but not sufficiently to allow full performance of duties.

An orthopedic entry on 7 February 2005 (7 months prior to separation) reported that the CI was able to run approximately a mile.  Examination showed normal muscle strength.  At the MEB exam on 2 May 2005 (4 months prior to separation), the CI reported pain with prolonged walking or with running.  He denied swollen or painful joints.  The MEB physical exam noted mild tenderness over the surgical region.  On 18 May 2005 the CI successfully completed the alternate Army physical fitness test aerobic walking event in 34 minutes.

The narrative summary on 25 May 2005 (4 months prior to separation) reported right leg pain that was primarily exertional and prevented activities such as frequent digging, stooping, heavy lifting, running or prolonged standing.  He was taking no medications.  Examination noted right leg tenderness, well-healed scars, and intact sensation and muscle strength.  Right knee extension was 0 degrees (normal 0 degrees) and flexion 145 degrees (normal 140 degrees).  Right ankle plantar flexion was 40 degrees (normal 45 degrees) and dorsiflexion 10 degrees (normal 20 degrees).

At the VA Compensation and Pension exam performed 12 days prior to separation, the CI reported pain in the right leg “with significant physical exertion, but not with the usual activities of daily living.”  Examination showed a normal gait, and no use of an ambulatory aid.  The right leg surgical scar was “barely noticeable…non-tender.”  There was no detectible fascial defect or herniation of muscle.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition at 0% coded analogously to 5003 (degenerative arthritis) IAW with the USAPDA pain policy.  The VA assigned a 10% rating under an analogous 5311 code (Muscle Group XI).  The Board agreed that a 5003 coding approach was a poor clinical fit in this case, and that a muscle code was the appropriate choice.  Regarding code 5311, the Board agreed that “moderately severe” muscle impairment required for a 20% rating was not present, but debated if key elements required under VASRD §4.56 for a 10% rating (“moderate”) were in evidence.  While “fatigue-pain” was possibly present, there were no documented complaints of other cardinal signs of muscle disability such as weakness, loss of power, or impairments of coordination and uncertainty of movement.  Board members considered if the ability to run a mile or walk 2.5 miles was consistent with “lowered threshold of fatigue after average use,” a key finding of moderate muscle disability.  Objective findings did not report loss of deep fascia, impairment of muscle tonus and loss of power, or lowered threshold of fatigue.  Board members concluded that the 10% rating criteria were not present; therefore the 10% rating was not warranted under this code.  There was likewise insufficient evidence of functional loss (VASRD §4.40) to warrant a 10% 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 rating for the right leg condition, but recommends assigning the 5399-5311 code in order to maintain stricter adherence to the VASRD.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating chronic pain of the right leg was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic pain of the right leg condition and IAW VASRD §4.73, the Board unanimously recommends no change in the PEB rating, but recommends VASRD code 5399-5311.  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 his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Pain of the Right Leg 	5399-5311	0%	
RATING	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20150017806, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability description should be modified.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure