RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02645
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for bilateral, exertional compartment syndrome.  The leg condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “chronic exertional compartment syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.   No other condition was submitted by the MEB.  The Informal PEB adjudicated “bilateral exertional compartment syndrome,” as unfitting, rated 20%.  The CI made no appeals and was medically separated.

CI CONTENTION:  The applicant requests consideration of all conditions in his application.  His complete submission is at Exhibit A.

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 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/Naval 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 

IPEB – Dated 20050712	VA* - (4 Yrs. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral, Exertional Compartment Syndrome	5399-5312	20%	Right Calf Compartment Syndrome	5399-5311	Deferred	20090530	
			Left Calf Compartment Syndrome	5399-5311	Deferred	20090530	
Other x 0 (Not In Scope)	Other x 4	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20090530 (most proximate to date of separation (DOS)). Subsequent VARD dated 20090911 rated the leg conditions at 0%.

ANALYSIS SUMMARY:

Bilateral Exertional Compartment Syndrome Condition.  The CI first experienced bilateral lower leg pain and associated numbness and tingling of both feet with exertional activity in approximately December 2003.  Symptom severity was always worse in the left than the right leg and occurred after running approximately 1 mile, marching more than 1.5 miles, fast walking or repetitive jumping.  Symptoms resolved after 25 minutes of rest.  Specialty evaluation in July 2004 determined the cause of symptoms to be elevated pressure within the legs (compartment syndrome).  Surgery was considered but reasonably declined by the CI.  On 15 March 2005 (5 months prior to separation), the CI failed the alternate walking fitness test.  At a follow-up appointment on 15 April 2005 (4 months prior to separation) the CI reported numbness of the left leg and foot after running.  Although similar symptoms were experienced in the right leg and foot, they were considered by the CI to be “minor.”  Physical examination at that time recorded a normal gait, and no leg swelling or tenderness.  The narrative summary (NARSUM) physical exam on 20 May 2005 (3 months prior to separation) noted a normal gait.  There was no swelling or tenderness of either leg; compartments were soft.  There were no abnormal skin changes.  Stretching the calf muscle did not cause pain.  At the MEB exam, the CI reported that he had “compartment syndrome in my left calf.”  He denied impaired use of his legs.  The MEB physical exam recorded normal findings of the lower extremities.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the right and left exertional compartment syndrome conditions under a single disability rating, coded analogously to 5312 (muscle group XII).  Although this coding choice (and the VA’s 5311 code; muscle group XI) was consistent with the clinical history and §4.73 standards, the PEB’s bundling approach was not compliant with VASRD §4.55 (principles of combined ratings for muscle injury) which stipulates that each muscle group must be rated separately.  The Board therefore considered if there was sufficient evidence to warrant a rating higher than 10% for either compartment syndrome condition.  It was agreed however, given the absence of a history of deep penetrating wound; consistent complaints of cardinal signs and symptoms of muscle disability; loss of deep fascia or muscle substance; or intermuscular scarring, that muscle impairment could not be characterized as “moderately severe.”  Therefore, the next higher 20% rating was not supported via this pathway. 

Due to symptoms of pain, numbness and tingling, a route to a higher rating using a peripheral nerve pathway IAW §4.124a standards was considered.  Under the 8724 peripheral nerve code (paralysis of internal popliteal), “mild” neuralgia warrants a 10% rating while “moderate” neuralgia justifies 20%.  In this regard, Board members noted that neurologic symptoms were infrequent (only after sufficient exertion) and brief, and that abnormal neurologic findings were never present.  It was concluded that “moderate” was not described by the evidence and that “mild” most accurately depicted the condition; therefore a 10% rating was justified via this pathway.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left exertional compartment syndrome condition and 10% for the right exertional compartment syndrome condition, both coded 5399-5312.  The Board also concluded that application of the bilateral factor IAW VASRD §4.26 were appropriate in this case, although it did not result in a higher rating. 

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.  In the matter of the bilateral exertional compartment syndrome condition, the Board unanimously recommends that it be rated for two separate conditions as follows:  left exertional compartment syndrome condition coded 5399-5312 and rated 10%; and right exertional compartment syndrome condition coded 5399-5312 and rated 10%; both IAW VASRD §4.73.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:
  
CONDITION	VASRD CODE	RATING	
Left Exertional Compartment Syndrome 	5399-5312	10%	
Right Exertional Compartment Syndrome	5399-5312	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXX, AR20160003696 (PD201402645)

1.  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, accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA