RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00305
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20140827
SEPARATION DATE:  20080111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SN/E-3 (Customer Service Clerk) medically separated for bilateral exertional compartment syndrome.  The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The bilateral exertional compartment syndrome condition, characterized as “compartment syndrome, unspecified” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition.  The Informal PEB adjudicated “bilateral exertional compartment syndrome” as unfitting, rated at 20%.  The remaining condition was determined to be Category II condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Rating should be changed because I’m still suffering from the condition as of today and has been ever since, plus I think the condition could have been caused by a disease called socroidusis.  I can’t stand or sit for long periods of time.  I cant interact with my son because I’m always in pain.  This condition don’t allow me to be active at all.  I’ve been depressed about this for years now and I steady suffering because I can’t support my kids and myself.” [sic]

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 bilateral exertional compartment syndrome condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The requested sarcoidosis and depression conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board.  Any conditions 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.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate 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 20071130	VA - (9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Exertional Compartment Syndrome	8799-8727	10%	Postoperative Compartment Syndrome (MG XI and XII) Left Lower Extremity	5311	20%	20081008	
		10%	Postoperative Compartment Syndrome (MG XI and XII) Left Lower Extremity	5311	20%	20081008	
Saphenous Neuritis of the Bilateral Lower Extremities	CAT II	NO VA ENTRY	20081008	
Other x 0 (Not in Scope)	Other x 0 (Not in Scope)		
Combined:  20%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20090326 (most proximate to date of separation)

ANALYSIS SUMMARY:

Bilateral Exertional Compartment Syndrome Condition.  The CI was well until June 2006 when he developed bilateral leg pain and paresthesias (abnormal sensations) while running.  Evaluation determined the cause of symptoms to be elevated pressure within the legs (compartment syndrome).  In June 2007 bilateral fasciotomies (surgical compartment releases) were performed, but he continued to experience lower extremity symptoms.

The narrative summary on 25 October 2007 (3 months prior to separation) reported that due to early return to activity in the post-operative period, hematomas (collections of blood) and wound breakdown occurred.  However, the wounds eventually healed and the hematomas resolved.  Follow-up magnetic resonance imaging documented adequate compartment releases.  The examiner noted complaints of ongoing numbness and tingling “in the saphenous nerve distribution” (front and inner aspect of leg).  The examiner also stated that until the PEB decision was reached, the CI should avoid “running, …prolonged walking… or entering any areas where his unsteady gait may pose a danger to himself or others.”  Physical exam showed soft compartments and a positive Tinel sign over the saphenous nerve bilaterally (tenderness suggestive of nerve related pain).  Full range-of-motion (ROM) of the lower extremities was present.  The examination was silent regarding gait or other functional observations.

At the MEB separation exam on 6 November 2007, the CI reported numbness, tingling and daily pain in the legs.  The non-medical assessment on 7 November 2007 indicated that the CI’s condition imposed few limitations on his work performance because the majority of his tasks were at a desk.

At the VA Compensation and Pension exam on 8 October 2008 (9 months after separation), the CI reported that his lower extremity symptoms were the same as prior to surgery.  He complained of bilateral calf numbness and of pain that occurred daily and lasted for hours.  The CI stated that rest would alleviate the pain, and he could continue his activities when the pain subsided.  Pain was not present at the time of the examination and symptoms of decreased coordination, increased fatigability, uncertainty of movement and weakness were denied.  He did not require assistive ambulatory aids.  He stated that he was unemployed due to his bilateral leg condition.  Examination showed an antalgic (limping) gait; however, he was “able to walk on toes, heels and tandem walk.”  Lower extremity muscle strength was normal and there was no atrophy, spasm or evidence of intermuscular scarring.  Pain during ankle ROM was reportedly present, but the site of pain was not specified.  There was no increase in pain, weakness, fatigue or lack of endurance after three repetitive motions of the ankle.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating for each leg was based on an analogous 8727 peripheral nerve code (neuralgia, internal saphenous nerve).  The PEB appropriately accounted for a bilateral factor IAW §4.26 and properly subsumed saphenous neuritis under the rating for compartment syndrome.  The VA rated each leg at 20% under muscle disability code 5311 (muscle Group XI).  While the CI’s disability is not specifically listed in the rating schedule, each of these coding approaches is reasonable.  The highest rating possible under code 8727 is 10%, but other routes to a higher rating were considered.  There was no consistent indication from the record that one lower extremity was significantly less severe than the other and clinical examination findings were similar.  Accordingly, Board members concluded that the same rating should apply to each lower extremity.  Under a clinically acceptable code 8722 (neuralgia of superficial peroneal nerve), the next higher 20% rating requires “severe” paralysis; but it was agreed this descriptor was not consistent with the evidence.  Other nerve coding options such as code 8721 (neuralgia of external popliteal nerve) and code 8724 (neuralgia of internal popliteal nerve) were considered, but deemed to be clinically inappropriate in this case.  Under the muscle coding approach used by the VA “moderately severe” paralysis is required for a 20% rating.  Board members debated however that key elements required under VASRD §4.56 for a “moderately severe” assessment were not in evidence.  For example, examinations did not consistently demonstrate pertinent “cardinal signs and symptoms of muscle disability” such as loss of power and weakness and impairment of coordination and uncertainty of movement.  Likewise, intermuscular scarring, and loss of deep fascia, muscle substance, or normal firm resistance of muscles were not present.  The Board therefore determined that the “moderately severe” stipulation was not met and a 20% rating was not supported via this pathway.  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 bilateral exertional compartment syndrome 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.  In the matter of the bilateral exertional compartment syndrome 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 20131220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	
XXXXXXXXXXXXXX
President
DoD 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 29 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 USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)