RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01624
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Motor Transport Operator, medically separated for “bilateral chronic exertional compartment syndrome of the lower extremities (LE’s) with recurrent pain,” with a disability rating of 20%.

CI CONTENTION:  The CI claimed he was given a lower rating by the Veterans Administration for his unfitting condition than the Physical Evaluation Board.  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 - 20080806	VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chronic LE Exertional Compartment Syndrome	5399-5312	
Left 10%, Right 10% 
	Compartment Syndrome, Right LE	8799-8722	0%	20090519	
			Compartment Syndrome, Left LE	8799-8722	0%		
RATING:  20%	COMBINED RATING:  60%	

ANALYSIS SUMMARY: 

Bilateral Lower Extremity (LE) Chronic Exertional Compartment Syndrome.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic bilateral LE pain began in February 2006 while running and performing road marches.  Coupled with pain, he additionally reported altered sensation extending from both calves to the ankles.  His condition was determined non-surgical and despite aggressive physical therapy (PT) and medications, his painful symptoms remained.  In October 2007, he was permanently profiled with the diagnosis of bilateral external compartment syndrome.  At the MEB NARSUM examination dated 6 February 2008, approximately 9 months prior to separation, the CI reported pain and bilateral leg swelling while running.  Additionally, he reported needle-like sensations extending down to both ankles.  His physical examination (PE) revealed a normal gait despite having the presence of tenderness, tightness, swelling, and stiffness of both lower extremities.  The commander’s statement dated 01 April 2008 implicated that the CI’s functional limitations included the inability to do 3 to 5 second rushes under fire, and the inability to move with a fighting load at least 2 miles.  He was noted as non-deployable.  At the VA Compensation and Pension (C&P) examination in May 2009 performed approximately 7 months after separation, the CI reported bilateral leg pain and swelling with prolonged walking which improved upon cessation of activities and rest.  He denied significant flare-ups or incapacitating events since his separation.  His LE focused PE was normal excepting tenderness over the front aspects of both legs.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned an analogous code of 5312 (Muscle Group XII) for a combined 20% rating (10% for each leg), citing §4.10 (functional impairment), §4.40 (functional loss), §4.45 (joints) and §4.59 (painful motion).  The VA assigned a 0% rating for each leg using the analogous 8722 code (musculocutaneous nerve; neuralgia) based upon the 7-month post-separation C&P examination, citing associated incomplete paralysis of foot movements which were mild.

While both the MEB and VA examinations clearly indicated tenderness about both lower extremities, the motor aspects of the PE were normal as indicated by an unaltered gait.  Board members agreed that the persistent altered sensation component to the CI’s symptoms clearly supports rating under a nerve code.  In this case, the identified nerve in relation to the altered sensation is the superficial peroneal nerve.  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 (0%), or at most the moderate (10%) degree.”  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%) for each leg near the time of separation.  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 adjudication for the bilateral LE chronic exertional compartment syndrome.

BOARD FINDINGS:  In the matter of the recurrent pain from bilateral chronic LE 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.  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 20140328, 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 XXXXXXXXXXXXXXXXXXXXXXX AR20160008335 (P-2014-01624)

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