RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00054
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheeled, medically separated for “bilateral lower extremity pain due to compartment syndrome” with a disability rating of 0%.

CONTENTION:  The condition worsened after separation.  The 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 - 20040310	VARD - 20040911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Pain due to Compartment Syndrome	5399-5312	0%	Compartment Syndrome, Left Lower Extremity	5399-5312	0%	20040603	
			Compartment Syndrome, Right Lower Extremity	5399-5312	0%	20040603	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bilateral Lower Extremity Pain due to Compartment Syndrome:  The PEB combined the right and left compartment syndrome conditions as a single unfitting condition coded analogously to 5312 (Group XII muscle function) and rated 0% for “slight” muscle injury.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the Disability Evaluation System or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower compartment syndrome condition began in January 1999 without a history of specific injury.  After surgical compartment release of each lower leg in 2000, symptoms were relieved for approximately 1 year but pain eventually returned.  Compartment testing performed in October 2002 indicated elevated pressures consistent with compartment syndrome bilaterally.  Radiographic evaluation in 2003 was negative.  Further conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral leg pains, recurrent” and “compartment syndrome, exertional” for PEB adjudication.

An orthopedic examiner on 22 July 2003 (10 months prior to separation) noted complaints of shin pain with exertion.  Examination showed non-tender anterior tibias and soft compartments.  Swelling was absent.  There was no pain with active or passive motion.  On 20 August 2003, the CI completed the physical fitness test two and a half mile walk in 32 minutes and 49 seconds.  The permanent profile dated 17 October 2003 identified “anterior knee pain/shin splints/exertional compartment syndrome” as L3, and permitted walking at own pace and distance.

At the MEB examination on 21 November 2003, 7 months prior to separation, the CI complained of continued pain of the anterior tibia areas.  He checked “No” for “Impaired use of…legs” and “Knee trouble.”  Physical examination showed tenderness of each mid-anterior tibia.  The commander’s statement on 11 December 2003 noted that profile restrictions precluded running and foot marches, but that he was “one of my best mechanics.”  Specific duty impairments were not mentioned.

The MEB NARSUM examination on 20 February 2004, 3 months prior to separation, noted complaints of intermittent bilateral shin pain and foot numbness that was exacerbated by climbing vehicles, jumping, running or other strenuous activities.  The pain sometimes occurred at rest.  Physical examination showed a normal gait.  Range of motion of the knees was normal and painless.  There was normal lower extremity muscle strength and sensation, and atrophy was absent.  Tenderness was present from the anterior aspect of the knees all the way down the shins.

At the 3 June 2004 VA Compensation and Pension (C&P) evaluation, performed 1 week after separation, the CI reported leg pain 4 times per week.  Severity level was 8/10 and was worse with running, sitting, climbing stairs and walking.  Rest alleviated the pain.  Physical examination showed a normal gait.  Lower extremity muscle strength was normal and surgical scars were non-tender.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral lower extremity pain 0%, analogously coded 5399-5312 (Group XII muscle function) for “slight” muscle injury.  The VA rated the compartment syndrome condition separately at 0% each, also analogously code 5399-5312 based on the VA C&P examination 1 week after separation, also citing a slight muscle disability.

The Board first considered whether the right and left compartment syndrome conditions, when considered independently, were separately unfitting for continued military service and therefore warranted separate ratings.  The STR showed complaints of bilateral leg pain due to compartment syndrome.  The NARSUM and MEB identified a bilateral condition as not meeting medical standards.  The Board unanimously agreed therefore, that the right and left compartment syndrome conditions were reasonably justified as separately unfitting and that they met VASRD criteria for separate ratings.  While the CI’s disability is not specifically listed in the rating schedule, the PEB’s and VA’s coding approach was consistent with the clinical history and §4.73 standards.  It was noted that neither leg condition was reported to be more or less severe than the other, and clinical examination findings were similar.  Accordingly, Board members concluded that the same rating should apply to each lower extremity.

It was agreed that “moderately severe” muscle impairment required for a 20% rating was not present, so debate settled on whether key elements for a 10% rating (“moderate”) were in evidence.  Board members debated if “fatigue-pain” should be conceded as a “consistent complaint” as stipulated under VASRD §4.56, and also considered that there were no documented complaints of other cardinal signs of muscle disability such as weakness, loss of power, or impairments of coordination and uncertainty of movement.  Objective findings did not report loss of deep fascia, or impairment of muscle tonus and loss of power.  It was ultimately concluded that the 10% rating criteria were not present; therefore the 10% rating was not warranted for either leg under this code.  There was likewise insufficient evidence of functional loss (VASRD §4.40) to warrant a 10% rating.  Given the rating recommendation as just elaborated, the Board concluded that there is no rating benefit to the CI in unbundling the bilateral compartment syndrome condition.  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 bilateral lower extremity pain due to compartment syndrome condition.

BOARD FINDINGS:  In the matter of the bilateral lower extremity pain due to compartment syndrome condition the Board unanimously recommends no change in the PEB adjudication.  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 20150113, 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 
XXXXXXXXXXXXXXXXXX, AR20160018837 (PD201500054)

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