RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01191
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070919

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle Systems Maintainer, medically separated for “exertional compartment syndrome, left leg,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that he should have a higher military disability rating and that his back condition with radiating pain to his right leg should be rated by the military.  The CI’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 based upon a 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 - 20070531	VARD - 20071205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exertional Compartment Syndrome, Left Leg	5399-5312	10%	Compartment Syndrome, Left Lower Extremity	8599-8520	10%	20070802	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Exertional Compartment Syndrome, Left Leg.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg condition began in November 2004 while running.  Radiographic studies were normal.  Orthopedic evaluation in April 2006 diagnosed the CI with chronic exertional compartment syndrome of the left leg.  The CI declined surgical intervention and despite restrictions and medication, his painful symptoms did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “exertional compartment syndrome, left leg” for PEB adjudication.  
At the orthopedic MEB examination dated 13 March 2007, 6 months prior to separation, the CI endorsed left leg pain with prolonged standing, running, and maneuvering stairs.  His physical examination (PE) revealed decreased, but near equal bilateral lower extremity range of motion (ROM).  Repetitive motion of the left leg created objective “tensing” as observed by the provider.  His pain rating was assessed as “frequent” and “moderate”.  At the VA Compensation and Pension (C&P) examination dated 02 August 2007, performed 2 months prior to separation, the CI reported numbness and tingling, altered sensation, and weakness of the left lower extremity without paralysis.  He additionally endorsed a constant pain described as squeezing, burning, and sharp in nature.  “At the time of pain he can function with medication.”  His functional impairment was described as constant weakness and pain in the [left] leg all the time and the inability to walk for long distance.  His PE revealed sensory dysfunction of numbness in the front aspect of the left lower extremity below the knee.  His muscular motor capability remained normal.  The provider noted the findings consistent with a neuritis of the left anterior tibial nerve. 
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition under analogous VASRD primary muscle code 5399-5312 at 10% impairment.  The VA also rated the condition at 10% utilizing the analogous primary code of 8520 (sciatic nerve; mild paralysis).  The PEB’s 10% muscle code rating was based on ‘moderate’ impairment while the VA’s 10% rating reflected a ‘moderately severe’ paralysis of the sciatic nerve.  While the CI’s disability is not specifically listed in the VASRD rating schedule, the PEB’s coding approach and rating remained consistent with the CI’s clinical history and §4.73 standards.  The VA’s coding approach under §4.124a was also reasonable but there was no clinical evidence specifically indicating sciatic nerve involvement.  The VASRD schedule of ratings under ‘Diseases of the Peripheral Nerves’ specifically states, “When the [nerve] involvement is wholly sensory, the rating should be for the [mild] or at most the [moderate] degree of impairment.”  Having no motor deficits, this case meets the “wholly sensory” criteria component under §4.124a standards and is most accurately described as being moderately impaired (10%) near the time of service separation.  Although VASRD code 8523 (Anterior tibial nerve; moderate incomplete paralysis) is specifically accurate as to the CI’s condition, its maximum rating according to §4.124a “wholly sensory” caveat would not provide any additional benefit to the CI in supporting criteria above the PEB’s current 10% rating.  Therefore, 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’s 10% adjudication for the left leg condition.      

BOARD FINDINGS:  In the matter of the left leg 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.  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 20140202, 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 AR20160013052 (PD201401191)

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