RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01410	
BRANCH OF SERVICE:  MARINE CORPS 	     separation DATE:  20080830 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Aviation Mechanic, medically separated for “exercised induced compartment syndrome, both lower extremities” and “status post four compartment fasciotomy in both lower extremities and evacuation of retained hematoma from posterior compartment, left lower extremity,” rated 0% and 10%, respectively, with combined disability rating of 10%.   

CI CONTENTION:  “The rating should be changed due to the understated severity of the condition at the time it was evaluated.  Multiple surgeries were completed in order to try and aid the symptoms.  Those surgeries have caused severe scarring, nerve damage and edema.  It continues to have an impact on day to day activities.”  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 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 - 20080623	VARD - 20081119 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Compartment Syndrome, Both Lower Extremities	5399-5311	0%	Exercise Induced Compartment Syndrome, Both Lower Extremities	No VA Entry	
Status Post Four Bilateral
Compartment Fasciotomy In Both Extremities And Evacuation Of Retained 
Hematoma From Posterior Compartment, Left
Lower Extremity	5399-5311	10%	Traumatic Compartment Syndrome, Status Post
Fasciotomy, Right Lower Extremity
	8520	10%	20080819	
			Traumatic Compartment Syndrome, Status Post
Fasciotomy, Left Lower Extremity	8520	10%	20080819	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:   

Bilateral Leg Condition.  In January 2008, the CI complained of symptoms in both lower extremities (LEs).  His symptoms included pain, numbness, tingling, swelling, and inability to run.  After pressure testing, he was diagnosed with compartment syndrome.  The CI had fasciotomy surgery on both legs, to try and remedy the problem.  In March 2008, another surgery was performed on the left leg, due to a hematoma in the posterior compartment.  After that, he continued to have problems with pain, numbness, and tingling in his legs.  Due to the chronic, persistent nature of his leg symptoms, an MEB was initiated.  The MEB physical examination (PE) was on 16 May 2008.  The CI reported that he had pain with any attempts at impact activity.  On PE, he was in no apparent distress.  His gait was slightly antalgic.  The surgical incisions were well-healed.  There was no redness, warmth, discharge, or drainage.  Both calves were soft and supple, with no swelling.  Muscle strength was normal.  Sensation was intact, except for an area of subjective decrease on the left calf.

The CI was medically separated on 30 August 2008.  Eleven days before separation, on 19 August 2008, he had a VA Compensation and Pension (C&P) examination.  He reported that his leg problem caused no significant effect on his usual occupation, but there was moderate effect on exercise and sports.  On examination, he was in no apparent distress. His posture was upright, and his gait was normal.  The surgical scars on his legs were nontender.  Neurological testing showed some loss of sensation on both lower legs, but muscle strength and reflexes were normal, and there was no evidence of muscle atrophy.  

The Board carefully reviewed all information available, and directed attention to its rating recommendation based on the evidence.  The Navy PEB used VASRD diagnostic code (DC) 5399-5311 (analogous to muscle injury).  The right leg was rated 0% (slight), and the left leg was rated 10% (moderate), for a combined rating of 10%.  The November 2008 VA Rating Decision (VARD) assigned a 10% disability rating to each leg, for a combined lower extremity rating of 20%.  After consideration of the physical examinations noted above, the Board determined that the August 2008 C&P examination had significant probative value since it was conducted just 11 days before the date of separation (DOS).  At that examination, the CI was in no apparent distress.  His posture was upright, and his gait was normal.  Muscle strength and reflexes were normal, and there was no evidence of muscle atrophy.  He reported that his leg condition caused a moderate effect on exercise and sports.
  
IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss) and §4.59 (Painful motion), when part of the musculoskeletal system becomes painful with use it must be considered disabled.  A disability rating of 10% is warranted when there is satisfactory evidence of functional loss and functional impairment due to pain. The Board determined that a disability rating of 10% for each leg was appropriate.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% disability rating for the chronic right leg condition.  In like manner, the Board recommends a 10% disability rating for the chronic left leg condition.   

BOARD FINDINGS:  In the matter of the chronic right leg condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5311, IAW VASRD §4.73.  In the matter of the chronic left leg condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5311, IAW VASRD §4.73. There were no other conditions within the Board’s scope of review for consideration. The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic right leg condition, status post fasciotomy surgery	5399-5311	10%	
Chronic left leg condition, status post fasciotomy surgery	5399-5311	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140319, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 11 Mar 16 ICO XXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 2 Mar 16 ICO XXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 14 Mar 16 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXX, former USMC: Assignment to the Temporary Disability Retired List for six months effective date of discharge with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a final disability rating of 30 percent.

     d. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USMC: Assignment to the Temporary Disability Retired List for six months effective date of discharge with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a final disability rating of 50 percent. 

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.