RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00299
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141113
SEPARATION DATE:  20060531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (0311/Rifleman Infantryman) medically separated for a left leg condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The left leg condition, characterized as “other specified congenital anomaly of muscle, tendon, fascia, and connective tissue,” “injury to nerves, unspecified site” and “unspecified orthopedic aftercare,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “status post left leg anterolateral compartment fasciotomies” as Category I condition, rated at 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be Category II condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Left leg compartment syndrome; 1 additional surgery permanently affects day to day life, requires daily brace use.  Also Dx) PTSD from 1st day of discharge.  With the injuries + surgerys to the left leg, psoriatic arthritis, + severe nerve damage to the point of the left leg having a burning sensation have occured.  This type of pain is not easily treated/managed.  It requires long periods of rest + can occur with any day to day activity.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left leg condition and contended and associated not-unfitting nerve and fascial damage are addressed below.  Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his left leg conditions continue to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service 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, operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20060417	VA* - (~1 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Leg Anterolateral Compartment Fasciotomies	5399-5312	10%	Residuals, Post-Operative Anterolateral Compartment Fasciotomies, Left Lower Leg	8522-5312	10%	20060411	
Peripheral Nerve Injury	Category II	No VA Entry	
Left Leg Fascial Defects	Category II	No VA Entry	
Other x 0  (Not in Scope)	Other x 14	
Combined:  10%	Combined:  80%	
Derived from VA Rating Decision (VARD) dated 20060728 (most proximate to date of separation)

ANALYSIS SUMMARY:

Left Leg Condition.  The narrative summary (NARSUM) noted the CI’s history of pain and swelling in his left leg began shortly after boot camp.  He initially presented with a bulge (muscle herniation) in the midlateral (mid shin) portion of his leg.  General surgery consultation dated 24 April 2003 indicated his symptoms began in late 2002.  The surgeon diagnosed fascial defect of the left leg (anterior compartment).  The defect was repaired.  Post-surgery magnetic resonance imaging of the left lower leg, 15 September 2003 demonstrated a fascial defect and no other significant findings.  In March 2005 he underwent fasciotomy (fascial release surgery) in the left leg and recovered without complication.  Post-surgery follow-up orthopedic visit performed on 14 June 2005 noted the CI had some pain and weakness in the left leg, the incision had healed and there was some ankle stiffness.  The CI participated in physical therapy (PT).  PT entry dated 11 July 2005 noted the CI had made some progress but had continued to have decrease ankle range-of-motion (ROM) and strength.  However, he reported he ran 2 to 2½ miles 3 times a week for 2 weeks and took a week off.  When he returned to running he noticed swelling on the lateral aspect.  The only recorded symptom that day was weak ankle.  

Orthopedic consultation to the MEB NARSUM dated 6 March 2006, (approximately 11 weeks prior to separation), noted the CI had returned to full duty in July 2005 but had continued to have pain, swelling and numbness in the leg.  The CI indicated he had swelling in the region of the surgical incision whenever he attempted to run.  He also noted burning sensation with radiation down into the lower leg and the foot.  He had some numbness distal to the incision.  Physical examination noted muscle bulging in the anterior compartment with no evidence of a fascial defect, there was decreased sensation and numbness in the area of the incision and distally in the distribution of the superficial peroneal nerve.  There was no evidence of infection.  Knee and ankle ROM were recorded as full and motor strength was normal.  The physician diagnosed left leg fascial defects and peripheral nerve injury.  The physician opined further surgery was not needed and it was unlikely the CI would be able to return to full duty or run because of pain and swelling of the leg.

The VA Compensation and Pension (C&P) examination, 11 April 2006, 6 weeks prior to separation, noted the CI’s leg pain was constant and non-radiating.  Pain was described as burning, sharp and throbbing with a severity rating of seven.  Pain was elicited by physical activity and relieved by rest and narcotic medications.  The CI reported since surgery, the left ankle was weak, stiff and lacked endurance with pain severity of one.  Physical examination recorded height of 68 inches and weight of 300 pounds.  His gait was normal.  Surgical scar was recorded as disfigured and tender, without evidence of inflammation.  The scar caused no functional impairment.  ROM of left knee recorded flexion of 130 with pain, and dorsiflexion of the left ankle of 10 compared to 15 in the right ankle.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of status post left leg anterolateral compartment fasciotomies analogously using code 5312 (function of anterior muscles of the leg) at 10% (moderate).  Likewise, the VA rated the condition at 10% coded analogously 5312.  The higher rating of 20% under code 5312 requires evidence of moderately severe disability demonstrated by hospitalization for a prolonged period for treatment of the condition, prolonged infection of the incision site, with record of consistent complaint of loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement reflected in the inability to maintain work requirement.  The 20% disability would also be warranted if there was evidence of severe incomplete paralysis of foot movement.  All Board members agreed the record in evidence did not support the 20% level of disability under this code.  There were no other applicable codes to consider for rating of this condition.

The PEB recorded the conditions of peripheral nerve injury and left leg fascial defect as Category II diagnoses which contributed to the primary left leg anterolateral compartment fasciotomies condition.  The Board first considered the condition of peripheral nerve injury and determined there was insufficient evidence that this condition resulted in any functional impairment.  The peroneal nerve is a superficial nerve that innervates muscles of the anterior compartment of the leg and travels into the ankle.  Damage to this nerve may cause the foot to drop, motor dysfunction in the toes and ankle weakness.  There was no evidence of any impairment in any part of the left lower extremity secondary to nerve injury.  The NARSUM examiner recorded full ROM of the left knee and ankle and no muscle weakness.  Although the C&P examiner recorded decreased dorsiflexion of the left ankle and knee, no functional impairment was identified.  Therefore, the Board concluded that this condition was not reasonably justified as separately unfitting.

The Board considered the left leg fascial defect condition was the inciting condition that resulted in the surgical intervention.  Therefore, the Board concluded this condition was an integral component of the status post left leg anterolateral compartment fasciotomies and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).

Thereupon, 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 status post left leg compartment fasciotomies condition.

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 status post left leg anterolateral compartment fasciotomies and left leg fascial defect conditions and IAW VASRD §4.73, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the peripheral nerve injury 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 20140105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 8 Apr 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXX
	     				  Assistant General Counsel
		  (Manpower & Reserve Affairs)