RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02087
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aviation Ordnance Systems Technician, medically separated for “peroneal nerve damage of the left lower extremity, resulting in foot drop,” with a disability rating of 20%.

CI CONTENTION:  The CI contends the rating is too low.  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 - 20040218	VARD - 20040913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Peroneal Nerve Damage of the Left Lower Extremity, Resulting in Foot Drop	8522	20%	Peroneal Nerve Dysfunction, Left Lower Extremity due to Arthroscopic Surgery	8521	40%	20040913	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Peroneal Nerve Damage of the Left Lower Extremity, Resulting in Foot Drop.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed a lower extremity neurologic deficit after a sustaining a traumatic fall while recovering from left knee surgery performed in March 2002.  Diagnostic imaging revealed persistent bone edema and clinical evidence corresponded well for sensory loss and distal weakness.  
Electro-diagnostic testing indicated a left superficial peroneal nerve palsy.  Further conservative treatment and restrictions did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “status post left knee arthroscopy” and “peroneal nerve damage of the left lower extremity, resulting in foot drop” for PEB adjudication.  At the MEB narrative summary (NARSUM) on 01 November 2003, 6 months prior to separation, the CI reported an altered numbing sensation throughout the majority of his left foot, sparing the great toe.  Additionally, he endorsed a constant left foot drop resulting in the inability to run and an increase likelihood of falling.  His physical examination (PE) revealed the absence of perceived sensation (nearby point discrimination, pain, or vibration) about most of the left foot.  Muscle atrophy was present on the top of the left foot.  There was no comment as to range of motion (ROM) of the left foot or ankle.  At the 13 September 2004 VA Compensation and Pension (C&P) examination, performed 5 months after separation, the CI denied having any adverse issue or concern with regards to his left knee, but rather he endorsed nerve damage in his left leg affecting his ability to either “walk and function” properly.  His PE revealed a left-sided altered gait.  There was “decreased sensation” of the entire left foot from about the level of the left ankle downward to light touch, temperature, position and pain.  He remained unable to dorsiflex or plantar flex his left foot at the ankle.  Both directions were measured at 0 degrees.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized differing VASRD nerve codes (8522; severe incomplete paralysis of the superficial peroneal nerve and 8521; complete paralysis of the common peroneal nerve) and rated 20% and 40% impairment respectively.  Board members first acknowledged and agreed that the PEB correctly identified the impaired nerve as the superficial peroneal nerve as described on electro-diagnostic testing; whereas the VA rated the condition under the common peroneal nerve.  Although there were clinical findings of sensory and motor activity deficits in the lower extremity with extensions into the left foot, there remained some intact neurologic function.  Therefore, the defined criterion of “complete paralysis” would not be appropriate in this case.  Board members agreed that the highest impairment rating under code 8522 for an incomplete paralysis of the superficial peroneal nerve of 20% was appropriately applied in this case.  The Board also considered alternative VASRD ankle and or foot codes, but all were less applicable and not advantageous to the current 20% rating.  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 adjudication for the left lower extremity condition. 

BOARD FINDINGS:   In the matter of the left lower extremity 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140512, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 11 Aug 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						         XXXXXXXXXXXXXXXXXXXX
	     				 	         Assistant General Counsel
	                             	 (Manpower & Reserve Affairs)