RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00456
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070410

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “bilateral lower extremity compartment syndrome” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  The CI’s complete submission is 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 on 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 - 20070319	VARD - 20070906	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Compartment Syndrome	5399-5312-8723	0%	Compartment Syndrome, Bilateral Lower Extremities, Muscle Group XII	5312	0%	20070518	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY: 

Bilateral Lower Extremity Compartment Syndrome.  The PEB combined two potentially separate conditions (compartment syndrome of the right and left leg) under a dual analogous disability rating code.  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 or implied adjudication that each condition was separately unfitting.  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.  To that end, the evidence for the bilateral compartment syndrome is presented; with attendant recommendations regarding separate unfitness, and separate ratings if indicated.

According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain condition began in January 2005 after running long distance.  Originally thought to be shin splints was later diagnosed as bilateral lower extremity compartment syndrome by orthopedics.  The MEB forwarded “compartment syndrome non-traumatic” for PEB adjudication.  The MEB NARSUM examination on 2 March 2007, 1 month prior to separation, noted complaints of intermittent 4/10 leg pain that was triggered by walking and became twice as painful if walking long distance or uphill.  The CI endorsed the inability to run or carry a basic fighting load.  The provider noted that the CI’s treatment management was “avoidance of aggravating factors” and rated the pain as “moderate” and “intermittent”.  His focused physical examination (PE) about the lower extremities was unremarkable and the final diagnosis was listed as “compartment syndrome; non-traumatic”.  At the 18 May 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI had no new or additional symptomatic complaints.  His limited PE revealed tenderness to both the back and front of the lower legs.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral compartment syndrome at 0%, analogously coded 5399-5321-8723 (muscle group XXI, paralysis-neuralgia of anterior tibial nerve), citing mild and incomplete paralysis.  The VA also rated the same condition at 0% under the muscle code of 5312, based on the VA C&P examination 1 month after separation, citing no penetration of any muscle groups.

Although the CI continued with subjective adverse symptoms, his physical evaluations near Service separation were normal in both lower extremities; revealing only the evidence of tenderness.  

Board members carefully reviewed the chronological STR during the 2 year pre-separation period and agreed that the CI’s overall condition, isolated treatments, and generally unchanging clinical symptoms remained nearly equivocal to both legs and therefore, further found it reasonable to surmise that either leg would have rendered the CI unfit to perform his MOS duties.  Therefore, separately unfitting muscle-related conditions are appropriate in this case.    

Members then considered a rating recommendation and agreed that near the time of separation neither leg manifested a degree of functional impairment that would support a muscle impairment rating above “slight” (0%) under code 5312.  Having no additional rating benefit in separate unfitting conditions with 0% each, all members agreed to the PEB’s current adjudication.  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’s adjudication for the bilateral lower extremity compartment syndrome condition.

BOARD FINDINGS:  In the matter of the bilateral compartment syndrome condition and IAW VASRD §4.73, 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 modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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, AR20170002985 (PD201500456)

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