RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03757
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated for “bilateral lower leg pains,” with a disability rating of 20%.

CI CONTENTION:  His condition continues to worsen, and he was not rated for PTSD or his neck.    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 - 20050922	VARD - 20061228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Lower Leg Pains	5399-5312	10%	Right Lower Extremity Fascial Defects	8520	10%	20060807	
	5399-5312	10%	Left Lower Extremity Fascial Defects	8520	10%	20060807	
Post-Traumatic Stress Disorder (PTSD)	Not Unfitting	PTSD	9411	50%	20060810	
Chronic Lower Back Pain	Not Unfitting	Lumbar Spine Degenerative Arthritis	5003-5242	10%	20060807	
History of Alcohol Abuse	Not Unfitting	No VA Placement	
Stab Wound to Right Hand	Not Unfitting	Right Hand Stab Wound (Major)	8599-8515	10%	20060807	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:  

Chronic Bilateral Lower Leg Pains.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), in 1997 while in basic training, the CI noticed non-tender, localized bumps above the ankle of both legs.  However, his history of bilateral leg pain with intermittent numbness in the right leg, began in 2004.  He was diagnosed with bilateral lower extremity anterior compartment fascial defects.  He was referred to orthopedic and underwent surgery of the left leg in January 2005 (fascial release surgery).  Electrodiagnostic studies (EMG, NCS) were negative for neuropathy.  Despite treatment, the bilateral lower extremity condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  

At the orthopedic MEB examination dated 14 July 2005, approximately 3 months before separation, the CI reported that he was unable to run or ruck due to the pain in his legs.  Physical examination recorded a normal gait, intact sensory and motor function in the peroneal distribution with reported decrease sensation in the saphenous nerve distribution.  The examiner noted a slight bulge in the right lower extremity consistent with a fascial defect, and indicated that there would be no recommendation for surgery.  The examiner assessed chronic exertional compartment syndrome with symptoms on the right greater than left.

At the MEB NARSUM on 7 September 2005, 2 months before separation, the CI reported he had pain primarily in his right leg, with intermittent swelling above the ankle.  He had numbness in his left leg, ankle and foot.  Pain increased from a baseline of 2/10 to 8/10 with any running or prolonged walking or standing.  The physical examination noted bilateral leg pain secondary to fascial hernia.

At the 7 August 2006 VA Compensation and Pension (C&P) examination, performed 9 months after separation, the CI reported pain in his lower extremities brought on by activity and relieved by rest.  His pain was constant, and he could function with pain without medication.  Physical examination showed absence of evidence of abnormal weight bearing and a normal gait.  There was paresthesia in the area of the surgery on the left, but sensation was intact.

The Board directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB rated the bilateral condition at 20% under the analogous 5312 code (Group XII muscles), citing continued exercise induced lower leg pains. The PEB also indicated that each extremity was rated at 10%, and therefore, the rating was not bundled.  The higher rating of 20% requires evidence of moderately severe disability of the muscle with prolonged infection or sloughing of soft parts and evidence of impairment related to strength and endurance, not supported by the evidence.  There was no path to a higher rating under the 8520 code.  Therefore, 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 lower leg conditions condition.  

Contended PEB Conditions:  PTSD, Chronic Lower Back Pain, History of Alcohol Abuse, and Stab Wound to Right Hand.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic bilateral lower leg pains condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD, chronic left lower back pain, history of alcohol abuse, and status post through and through stab wound to right hand conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140813, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017217 (PD201403757)

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