RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00041
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Human Resources Specialist, medically separated for “exercise induced compartment syndrome,” with a disability rating of 0%.

CI CONTENTION:  The CI contends her condition continues to worsen.  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 - 20070927	VARD - 20080324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exercise Induced Compartment Syndrome (ECS)	5399-5312	0%	Fascial Herniation and ECS…	5326	10%	20070620	
Carpal Tunnel Syndrome, Left Hand	Not Unfitting	CTS, Left Hand	8515	10%	20070620	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Exercise Induced Compartment Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first reported a right leg “lump” in March 2006 during a follow up appointment in physical therapy (PT) for an unrelated right ankle condition.  She was noted to have swelling and a fascial defect in the right lower leg, but did not have tenderness.  X-rays of the lower leg and an MRI of the right calf were normal.  Although she did not initially report pain in the calf, she noted exercise related discomfort as her activity level increased following rehabilitation of the ankle.  She was diagnosed with an exercise (induced) compartment syndrome (ECS) as well as a fascial defect in the lower right leg.  Non-operative treatment did not allow the return to full duty.  Surgery was discussed, but the CI elected to pursue an MEB when told that there was no guarantee that surgery would allow continuation on active duty.  

At the VA Compensation and Pension (C&P) evaluation, performed on 20 June 2007, 5 months before separation, the CI reported pain and swelling if she walked over 1/4 mile.  On examination, the posture and gait were normal.  She was noted to have a 1.5 cm x 1.5 cm tissue bulge which was not tender to palpation.  The ankle range of motion (ROM) was normal and actually better than the left ankle.  The neurological examination was normal.  The MEB NARSUM examination was performed on 29 August 2007, 3 months prior to separation, by the treating orthopedic surgeon.  The CI reported difficulty with standing or walking for long periods of time as well as running.  On examination she had a palpable mass and fascial herniation.  The ROM of the foot and ankle was normal.  The MEB forwarded “exercise-induced compartment syndrome,” “right leg fascial herniation,” and “carpal tunnel syndrome, left hand,” for PEB adjudication.  On 27 August 2008, just over 9 months after separation, the CI requested reevaluation for possible re-entry onto active duty.  Her gait and stance were normal and she was referred to orthopedics.  She reported that she no longer had pain with exercise and was able to run again.  The examination was normal without tenderness and the fascial defect was no longer apparent.  Re-enlistment was recommended.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the exercise induced compartment syndrome 0%, coded 5399-5312 (analogous to a slight impairment of the Group XII muscles).  The VA rated fascial herniation and exercise induced compartment syndrome 10%, coded 5326 (muscle hernia).  The CI had a normal gait, motor examination and ROM.  This is not consistent with a moderate level of impairment under the code 5312 and a 10% rating is not supported for this coding option.  However, multiple examinations prior to separation did note the presence of a fascial defect which supports a 10% rating under the 5326 code which was used by the VA.  The Board also noted for the record that separate ratings for the exercise induced compartment syndrome and the fascial defect would violate VASRD §4.14 (avoidance of pyramiding) as the symptoms and impairment overlap.  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 right lower leg condition, coded 5326.  

Contended PEB Conditions:  Left Carpal Tunnel Syndrome (CTS).  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled, although not until the final profile, and judged to fail retention standards.  The commander noted that she was able to fulfil the requirements of her specific occupation, but that she could not perform basic soldiering skills.  The PEB noted that her NCOERs documented outstanding performance.  While there is medical evidence that the CTS impaired full duty performance, the evidence from the supervisory chain is that the CI had 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 the contended condition and so no additional disability rating is recommended.   

BOARD FINDINGS:  In the matter of the exercise induced compartment condition, the Board unanimously recommends a disability rating of 10%, coded 5326 IAW VASRD §4.73.  In the matter of the contended carpal tunnel syndrome condition, 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Exercise Induced Compartment Syndrome	5326	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150109, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018793 (PD201500041)

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 rating to 10% without 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