RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01968
BRANCH OF SERVICE:  Army	BOARD DATE:  20140806
SEPARATION DATE:  20040411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (11B/Infantry) medically separated for a right calf and ankle condition.  The right calf and ankle condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Right ankle pain and right leg pain were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right calf and ankle, status post fasciotomy and hematoma drainage” as unfitting, rated 10%, referencing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI stated “please consider all conditions.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right calf and ankle pain is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040212	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Calf and Ankle, s/p Fasciotomy and Hematoma Drainage	5099-5003	10%	Chronic Pain, Right Calf and Ankle, s/p Fasciotomy and Hematoma Drainage	5311	10%	STR	
Other x 0 (Not is Scope)	Other x 2		
Rating: 10%	Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20050617 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Pain, Right Calf and Ankle, s/p Fasciotomy and Hematoma Drainage.  The first treatment record entry in evidence is from 1 June 2003.  The CI was evaluated for right calf muscle pain for 1.5 days after a basketball injury.  He stated he jumped and felt a sharp pain on his right calf upon landing.  He was diagnosed with shin splints by the physician’s assistant.  Re-evaluation on 24 June 2003 found a fascial muscular defect and an obvious muscle belly herniation on physical examination.  The CI was placed on profile and recommended for medical evacuation from theater for surgical correction.  The operative report for the anterior and lateral fasciotomy of the right calf on 18 August 2003 did not expect to return the CI to duty due to somatization or secondary gain.  The CI was seen again for increased pain and swelling to the right lower leg on 2 September 2003.  At that time he claimed that his leg was run over by a Humvee (for which there was no documentation found and not a re-injury), and then had the surgery of his right leg.  He was found to have high compartment pressures of the calf and taken to surgery for evacuation of a large hematoma on 23 August 2003.  He had continuing pain.  He was diagnosed with regional complex pain syndrome for which a paravertebral sympathetic block was performed, with good response.

The narrative summary dictated on 21 November 2003, 5 months prior to separation, notes the CI was not able to perform his military duties.  The prognosis was for improvement, but not to the point where he could resume his duties.  Physical examination found he sat, walked and stood with discomfort and a limp on the right.  He could heel-and-toe walk with pain (which would indicate full strength of the leg muscles).  There was a 4 cm vertical by 2 cm wide fascial defect of the anterior compartment in the distal one third of the leg.  There was a 2 cm wide, 1 cm elevated soft bump over the lateral compartment, 8 cm proximal to the ankle.  There was no effusion, no tenderness, and neurovascular examination was intact.  There was breaking of the ankle and toe flexion and extension upon strength testing.  Range-of-motion was full (20 to 45 degrees flexion.

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic codes 5099-5003 (rated analogously to degenerative arthritis) used by the PEB for a 10% rating.  The Board did not find evidence in the treatment record for a higher rating under this code.  The Board then considered VASRD §4.73 code 5311 (leg muscle Group XI) which the VA used for a 10% rating (moderate).  No VA Compensation and Pension examination was in evidence proximal to the date of separation; the service treatment records were used to obtain the rating.  There was no evidence in the record that the muscle injury could be described as moderately severe for a higher rating.  The Board estimated that there was sufficient strength for normal toe and heel gait testing.  The breaking of the right toe flexion would indicate a 5-/5 versus 5/5 on the left which did not arise to the level of a moderately severe weakness.  The Board considered this code more descriptive of the injury, but the alternate coding did not provide a rating advantage.  The Board also considered a §4.124a neurological rating.  The Board found no evidence for a higher rating in the CI’s favor under applicable codes including paralysis, neuritis, or neuralgia.  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 adjudication for the chronic pain, right calf and ankle, status post fasciotomy and hematoma drainage condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the chronic pain, right calf and ankle, status post fasciotomy and hematoma drainage condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic pain, right calf and ankle, status post fasciotomy and hematoma drainage condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

RECOMMENDATION:  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 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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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 AR20150006498 (PD201401968)

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:

Encl						     XXXXXXXXXXXXXXXXXX