RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00540
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-4, signals Intelligence Analyst, medically separated for “chronic bilateral exertional compartment syndrome,” with a disability rating of 0%.

CI CONTENTION:  He was never compensated for chronic exertional compartment syndrome, which was the basis for his discharge.  The applicants 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 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 - 20060322	VARD - 20070130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Exertional Compartment Syndrome	5399-5311	0%	Right Leg Compartment Syndrome	5399-5311	0%	20061130	
			Left Leg Compartment Syndrome	5399-5311	0%	20061130	
COMBINED RATING:  0%	COMBINED RATING:  20%	

ANALYSIS SUMMARY:

Bilateral, Exertional Compartment Syndrome.  At the time of the Medical Evaluation Board (MEB) narrative summary (NARSUM) (01 March 2006; 3 months prior to separation), the CI experienced bilateral leg pain and foot numbness shortly after initiating running with resolution of the same symptoms upon cessation of activity and rest.  Additionally, he endorsed bilateral leg pain when maneuvering three flights of stairs or with weight loads such as ‘rucking’.  Orthopedics diagnosed the CI with bilateral exertional compartment syndrome (…when tissue pressure within a closed muscle compartment exceeds the surrounding blood flow pressure…possibly resulting in muscle and or nerve damage).  His physical examination of both lower extremities revealed no swelling, warmth or redness, no tenderness on palpation, normal foot alignment, and good distal pules.  The examiner listed the CI’s condition as chronic and stable.

The VA Compensation and Pension (C&P) examination performed 30 November 2006 (7 months after separation) revealed a normal gait and normal muscular strength in the lower extremities.  There was no VA diagnosis relating to a compartment syndrome condition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the bilateral lower extremity condition as a single unfitting condition analogously coded 5399-5311 (Group XI…Propulsion, plantar flexion of foot…) and rated 0%.  The Board’s initial charge in this case was directed at determining if the PEB’s approach of combining both legs under a single rating was justified in lieu of separate ratings.  Members first agreed that exam probative value in determining a rating be exclusively apportioned to the NARSUM due to close reference to his separation.  Additionally, members agreed that the lower extremity conditions were clinically best captured under the 5311 muscle code as utilized by the PEB.  Although the CI’s bilateral painful symptoms were reported to be relieved with rest or cessation of activities, all Board members agreed that the same condition being isolated to either leg separately would still render the CI unable to perform his military duties such as running and or rucking; and, accordingly a separate disability rating is recommended.  The Board considered the four rating levels of 5311 and concluded that the self-reported evidence of symptom resolution with rest coupled with a normal NARSUM examination would best be described as a slight impairment.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends separate disability ratings of 0% for the right and left lower extremities.  However, such separate rating determinations of 0% and 0% would be of no additional benefit to the CI as compared to his current bundled 0%.  Therefore, the Board’s final recommendation is no change from the current PEB rating.

BOARD FINDINGS.  In the matter of the bilateral lower extremity exertional compartment syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140102, 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, AR20160005542 (PD201400540)

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