RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01412
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20081006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Combat Controller, Trainee, medically separated for “bilateral calf pains with dysesthesia,” with a disability rating of 20%. 

CI CONTENTION:  The applicant’s condition continues to worsen and negatively impacts his daily activities.  The applicant’s complete contention 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 - 20080730	VARD - 20090305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Calf Pains with Dysesthesia
	8799-8722	20%	Residuals, Four Compartment Syndrome, s/p Fasciotomy w/ Peripheral Neuropathy, Left Leg 	8599-8520	20%	20081029	
			Residuals, Four Compartment Syndrome, s/p Fasciotomy with Peripheral Neuropathy, Right Leg	8599-8520	20%	20081029	
Status-post Four Compartment Bilateral Leg Fasciotomies for Bilateral Compartment Syndrome of the Lower Extremities	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Calf Pains with Dysesthesia.  The service treatment record indicated that the CI was diagnosed with chronic bilateral lower extremity exertional compartment syndrome for which he underwent bilateral surgical fascial release in 2007.  Post-operative Orthopedic follow-up in March 2008 revealed continued bilateral anterior lower leg pain when running up to 2 miles.  Electro-diagnostic studies were normal.  He was subsequently profiled and referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination (25 April 2008; 5 months prior to date of Service separation), the CI’s chief complaint was “bilateral calf pains.”  The physical examination (PE) was cursory and listed both lower extremities as having normal 5/5 strength.  Additionally, it was noted that the CI was not taking any medication.  His diagnosis remained bilateral calf pains with dysesthesia (abnormal sensation).  At the VA Compensation and Pension examination (29 October 2008; 3 weeks after DOS), the CI reported continued bilateral calf pain.  The PE was extensive and normal excepting for decreased pinprick and vibratory sensation over the outside aspect of both lower legs and feet.         

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% separate rating of each lower extremity was based analogously on code 8722 for moderate neuralgia of the superficial peroneal nerve, while the VA’s 20% separate rating for each leg reflected use of analogous code 8520 for moderate incomplete paralysis of the sciatic nerve.  While the CI’s disability is not specifically listed in the rating schedule, the PEB’s coding approach and rating is consistent with the CI’s clinical history and §4.124a standards.  The VA’s coding approach is also reasonable (tending to a nerve code), but there is 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 (10%), or at most the moderate (20%) degree.”  Having no motor deficits and only decreased sensation, this case meets the “wholly sensory” criteria component under §4.124a standards and is most accurately described as involvement of the peroneal nerve as mildly impaired (10%) near the time of Service separation.  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 overall 20% adjudication for the bilateral lower leg conditions.       

Contended Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the status-post four compartment bilateral leg fasciotomies for bilateral compartment syndrome of the lower extremities was a Category II condition (a condition that can be unfitting but is neither currently compensable nor ratable).  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  All Board members agreed that the identified Category II condition was simply the accurate description of the surgical procedure that resulted in the bilateral leg condition and any adherent features of the surgical procedure was subsumed in the rating as described above.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s determination for the status-post surgical procedure; and, therefore, no additional disability rating can be recommended.

BOARD FINDINGS:  In the matter of the bilateral lower leg condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended status-post surgical procedure condition, the Board unanimously agreed that it cannot recommend it for additional disability rating.  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 20140321, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01412.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Record of Proceedings