RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00347
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Ammunition Specialist, medically separated for “bilateral lower extremity compartment syndrome” with a disability rating of 0%.   

CI CONTENTION:   The CI requested a review of 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 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 IPEB - 20070716	VARD - 20071226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Compartment Syndrome	5399-5312-8723	0%	Left Lower Leg Compartment Syndrome	8799-8722	0%	20070723	
			Right Lower Leg Compartment Syndrome	8799-8722	0%	20070723	
Bilateral Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%	20070723	
Hypercholesterolemia	Not Unfitting 	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY: 

Bilateral Lower Extremity Compartment Syndrome.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral lower leg pain condition began in in May 2006 while running distances of three miles after he returned from deployment.  Orthotics were prescribed for mild pes planus with tarsal tunnel syndrome versus exertional compartment syndrome in early June 2006.  With continued running, but shorter distances, the CI had bilateral lower leg pain with paresthesias and bilateral foot drop, which resolved within 10 minutes after the run.  In July 2006 he had physical therapy instruction and evaluation at the orthopedic clinic where he was given a profile and prescribed ibuprofen (a nonsteroidal anti-inflammatory drug (NSAID)).  Compartment pressure measurements of the left lower leg revealed post-exercise elevations of 10 mm Hg in the lateral compartment, 8 mm Hg in the anterior compartment, 7 mm Hg in the posterior compartment, and 1 mm Hg in the deep posterior compartment.  Surgery was deferred and a profile for 90 days of no running was issued.  NSAID use and physical therapy were continued.  In November 2006, after running on a treadmill for 10 minutes the CI had pain in the calves and feet, paresthesias, and paralysis (foot slap demonstrated), which resolved after 15 minutes rest.  A bone scan in January 2007 revealed no evidence of shin splints or stress fractures, but there was a focal increased uptake in the articular surface of the distal left femur, which may have represented osteochondritis dissecans or a benign bone lesion. Probable exercise-induced compartment syndrome with borderline numbness was diagnosed and a permanent profile was issued.  On examination in February 2007, the CI was tender to pressure on the posteromedial tibias bilaterally without any fascial (a membrane surrounding muscle) defects palpable.  Despite treatment, the bilateral lower extremity compartment syndrome condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “compartment syndrome” for PEB adjudication.

At the MEB examination in May 2007, approximately 3 weeks prior to separation, the CI reported numbness, tingling, pain and impaired use of the legs after running, ruck marches, long walks or prolonged standing.  The examiner noted the symptoms were infrequent (once a month), unless the CI was marching or running.  Symptoms lasted 30 minutes.  On the clinical examination lower extremities were checked normal and pes planus (see below) was noted to be mild.

At the VA Compensation and Pension (C&P) examination on 23 July 2007, performed less than 3 weeks before separation, the CI reported pain in the lower legs and feet once a week for about 45 minutes, which was elicited by physical activity and relieved by rest.  The CI was not receiving any treatment and the functional impairment was limited weight bearing and impact activities during flares.  Physical examination revealed a normal gait without any assistive device for ambulation.  Neurological evaluation the lower extremities was normal. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5399-5312-8723 code (Group XII. Function: Dorsiflexion (1); extension of toes (2); stabilization of arch (3).  Anterior muscles of the leg: (1) tibialis anterior; (2) extensor digitorum longus; (3) extensor hallucis longus; (4) peroneus tertius-anterior tibial nerve (deep peroneal)-mild neuralgia), citing bilateral lower extremity compartment syndrome, which precluded the CI from performing most solder functional activities as well as heavy lifting and carrying tasks.  The VA also assigned a 0% rating using an analogous 8799-8722 code (musculocutaneous nerve (superficial peroneal) neuralgia mild) based on the VA C&P examination less than 3 weeks before separation, citing left lower leg compartment syndrome with a normal neurological examination with no evidence of sensory or motor dysfunction and a 0% rating using an analogous 8799-8722 code (musculocutaneous nerve (superficial peroneal) neuralgia mild), citing right lower leg compartment syndrome with a normal neurological examination with no evidence of sensory or motor dysfunction.  

The PEB combined the bilateral lower leg compartment syndrome conditions as a single unfitting condition coded 5399-5312-8723 for anterior tibial nerve (deep peroneal) mid neuralgia and rated 0%. The approach by the PEB commonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board’s initial charge in this case was 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 DES 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.  The evidence for the bilateral compartment syndrome condition was presented together above.  In this case, the bilateral lower extremity deep posterior compartment syndrome was addressed in the profile as right and left leg pain and the bilateral compartment syndrome condition was implicated by the NARSUM, although not explicitly in the commander’s statement.  Members agreed that each lower leg condition is separately unfitting and that identical coding and ratings are applicable.  However, the pain that the CI experienced in each leg when running resolved rapidly with rest.  Therefore, it is difficult to conceive that the condition was anything but mild, once the CI stopped running and use of the analogous code of 8723 (anterior tibial nerve (deep peroneal) or 8722 (musculocutaneous nerve (superficial peroneal) for mild neuralgia for either the right leg or left leg would provide only a rating of 0% for each leg, the combination of which would provide no additional benefit to the CI.  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 leg compartment syndrome condition.  

Contended PEB Conditions: Bilateral Pes Planus and Hypercholesterolemia. 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 bilateral lower leg compartment syndrome condition and IAW VASRD §4.73 and VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral pes planus and hypercholesterolemia 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 20150527, 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

20 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018686 (PD201500347)

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