RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03964
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “bilateral [left and right leg] compartment syndrome,” rated 10% and 10%, respectfully, with a combined disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  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 – 20071005	VARD - 20080417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Compartment Syndrome, R Leg	5399-5312-8723	10%	L Leg Compartment Syndrome	5299-5262	NSC	20080225	
Compartment Syndrome, L Leg		10%	R Leg Compartment Syndrome				
Postablation Hypothyroidism	Not Unfitting	Hypothyroidism	7903	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bilateral (Left and Right Leg) Compartment Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed bilateral lower extremity (BLE) pain (anterior tibial) with running in April 2007 (7 months before separation).  A bone scan excluded shin splints and he was diagnosed with exertional compartment syndrome by orthopedics.  The consultant noted the onset of BLE pain after running “½ mile then feet go numb at 2 miles.”  There was no outpatient STR evidence for gait disturbance or additional functional impairment; or, for significant range of motion (ROM) limitation or other VASRD-ratable criteria.  Surgery (fasciotomy) was discussed and reasonably declined.  A continued trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “bilateral compartment syndrome” to the PEB.

The MEB NARSUM examination in September 2000 (2 months before separation) documented “moderate and constant” BLE pain “exacerbated simply by standing.”  The BLE physical examination was, “Nontender to palpation.  Strength 5/5.  Unremarkable exam.”  The MEB NARSUM referenced formal ROM measurements for the MEB from a day earlier.  For the knees, these were (all bilateral) flexion to 130 degrees (normal 140, 45 for minimum 10%) and extension 0 degrees (normal), specifying the absence of painful motion.  For the ankles (all bilateral), dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal), specifying the absence of painful motion.

A VA Compensation and Pension (C&P) examination in February 2008 (3 months after separation) documented “constant” BLE pain rated 3/10 with flares to 9/10 that rendered the CI unable to “run ... [or] ... do repetitive activities such as climbing stairs.”  The physical examination recorded a normal gait and provided detailed and normal BLE findings (including ratable knee findings).  The examiner recorded bilateral ROM measurements for the hips, knees and ankles that specified VASRD-normal values for all planes of motion; and, for each specified “not limited by repetitive use, pain, fatigue, weakness, lack of endurance, or incoordination.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s rated the right and left leg (bilateral) compartment syndrome conditions 10% each, analogously coded 5399-5312-8723 (Muscle Group XI-anterior tibial nerve), citing moderate incomplete paralysis.  The VA did not service-connect either right or left leg, analogously coded 5299-5262 (tibia and fibula, impairment) based on the C&P examination 3 months after separation, citing no permanent residual or chronic disability subject to service connection.

The Board agreed the muscle and nerve codes were each anatomically accurate for the pathology, and both confer 10% ratings for “moderate” disability.  The 20% ratings are “moderately severe” for 5312 and “severe” for 8723.  Members considered application of the VA’s analogous code 5299-5262 (tibia and fibula, impairment) in support of a higher rating; but, agreed that the analogous application of this fracture code (with no fracture present) was not sufficiently justified by VASRD §4.20 (analogous ratings) in a case such as this which satisfies compensable criteria under more applicable joint codes.  Members agreed that the functional evidence (normal gait, limitations confined to more strenuous activities) was insufficient to justify a rating for than moderate disability under either the muscle or the nerve code, especially considering that it would apply separately to each extremity, and separate rating of overlapping nerve and muscle disability is prohibited by VASRD §4.14 (avoidance of pyramiding).  There was no compensable ROM limitation or evidence for any other ratable finding supporting a rating higher than 10% under any other applicable code available in VASRD §4.71a.  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 of the bilateral (left and right leg) compartment syndrome condition.

Contended PEB Condition:  Hypothyroidism.  The CI was diagnosed in service with mild hypothyroidism (history of radiation therapy for childhood lymphoma) which was well controlled on medication.  The Board’s main charge was to assess the fairness of the PEB’s determination that the condition was not unfitting.  The hypothyroidism was clinically stable at the time of separation.  It was not profiled or implicated in the commander’s performance statement; did not result in work loss; and, was judged to meet retention standards.  Members thus agreed that there was no performance-based evidence indicating that it significantly interfered with duty requirements.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hypothyroidism; thus, it was not eligible for rating.

BOARD FINDINGS:  In the matter of the bilateral (left and right leg) compartment syndrome condition and IAW VASRD §4.73 and §4.124a, the Board unanimously recommends no change in the PEB adjudications.  In the matter of the contended hypothyroidism, the Board unanimously recommends no change from the PEB determination 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 20140910, 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

30 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017904 (PD201403964)

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