RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02675
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20050929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Assault Amphibian Vehicle Crewman, medically separated for “status post left forearm fasciotomy,” with a disability rating of 20%.

CI CONTENTION:  “Was expecting retirement made career enlistment plans.”  The CI’s complete submission can be found 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 – 20050728	VARD - 20060427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Forearm Fasciotomy	5399-5309-8714	20%	Status Post Left Forearm Fasciotomy due to Compartment Syndrome with Residual Scars and
Hyperesthesia	8099-8715	10%	20060406	
History of Compartment Syndrome	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30	

ANALYSIS SUMMARY:  

Status Post Left Forearm Fasciotomy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a crushing injury to his left forearm in October 2004 which required surgical intervention due to a developing compartment syndrome.  His post-operative rehabilitation globally improved his condition to the point of residual weakness and decreased sensation in his forearm; however, his end-state rehabilitative improvement did not allow for unrestricted duty.  The MEB forwarded “other early complications of trauma” for PEB adjudication.  

At the MEB NARSUM physical examination (PE) performed 4 months prior to separation, the CI reported decreased sensation and weakness of the left forearm.  His PE revealed 50% comparative weakness in left hand grip and an unquantified sensory deficit of the posterior aspect of the left forearm.  There was no muscle atrophy and vascular refill status was normal.  At the VA Compensation and Pension (C&P) examination performed 6 months after separation, the CI reported constant numbness in areas about his left forearm and hand.  His functional limitation was listed as, “…can’t lift heavy objects.”  His PE revealed altered sensation about the left distal forearm.  His upper extremity range of motion (ROM) was normal and X-rays of the left forearm were normal.  There is no record of electro-diagnostic studies being performed.    

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB’s 20% rating was based on an analogous code of 5399-5309-8714 (muscle group IX; forearm muscles-neuralgia [mild] of radial nerve), while the VA’s 10% rating reflected use of an analogous code of 8715 (neuralgia [mild] of median nerve).  Board members agreed that although weakness was clearly demonstrated in the left upper extremity, the absence of muscle atrophy with altered sensation more appropriately described a residual neurologic pathology and therefore, is best rated under §4.124a standards.  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.”  However, this case involved both sensory and motor deficits as portrayed in altered sensation and significant weakness in the left forearm.  Therefore, a VASRD rating in this case was not limited to a ‘moderate’ degree of impairment, if applicable.  Having no electro-physiologic identification of the specific involved nerve(s), all Board members agreed that more than a single nerve was involved based upon clinical evidence and therefore, the most appropriate rating code would be that of the ‘lower radicular group’.  The decreased ability in sensation without muscular atrophy or abnormal reflexes clearly indicated a neuritis of the lower radicular group of nerves.  Board members considered the degree of impairment and totality of the evidence, mindful of VASRD §4.3 (reasonable doubt), and concluded that the documented 50% comparative weakness in the left upper extremity was indicative of an impairment above ‘mild’ and below ‘severe’.  The Board recommends a ‘moderate’ disability rating of 30%, coded 8612 for the non-dominate arm condition. 

The documented Category II condition of “history of compartment syndrome” was the actual diagnosis resulting in the primary unfitting condition, and therefore any associated specific symptoms were subsumed under the recommended rating.  

BOARD FINDINGS:  In the matter of the left arm condition, the Board unanimously recommends a disability rating of 30%, coded 8612, IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Forearm Fasciotomy	8612	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 26 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)