RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01283
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Imagery Analyst, medically separated for “bilateral chronic exertional compartment syndrome” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions”.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050415	VARD - 20060427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chronic Exertional Compartment Syndrome	5399-5312	0%	Exertional Compartment Syndrome, Left Leg with Degenerative Changes	5010-5022	10%	20051216	
			Exertional Compartment Syndrome, Right Leg with Degenerative Changes	5010-5022	10%	20051216	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Chronic Exertional Compartment Syndrome Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral lower leg condition began when he joined the military with increased activities.  Symptoms were bilateral knee pain with running and shin splints.  No specific trauma or injury was reported.  Radiographic studies showed normal knees as well as tibiae and fibulae.  Nuclear Medicine study showed stress reaction changes in the tibiae and fibulae bilaterally.  The CI’s work-up, including abnormal exertional compartment pressure testing, was determined to be consistent with chronic bilateral exertional compartment syndrome.  The CI was offered surgery (fasciotomy – compartment release), but opted to employ nonsurgical treatment.  Despite treatment, the bilateral lower leg 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 “bilateral chronic exertional compart syndrome” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2005, 3 months prior to separation, the CI reported bilateral knee and leg pain with swelling and popping of the knees and bilateral feet numbness and paresthesias following exertion.  Physical examination showed full range of motion (ROM) of both knees with crepitus.  Neurovascular examination was normal.  

The MEB NARSUM examination on 3 March 2005, 2 months prior to separation, noted complaints of bilateral leg pain and tightness worse with activity and associated calf swelling and foot numbness/paresthesias.  Physical examination showed normal gait and ability to walk on both toes and heels.  There was full active ROM of the hips, knees, and ankles.  There were no knee effusions.  There was palpable firmness to his leg compartments with no appreciable fascial hernia.  Strength and pulses were normal.  

At the 16 December 2005 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported bilateral painful, limited motion of both legs especially with performing any exercise and with recreation sports.  There were subjective complaints of pain and swelling in both calves after exercise, with numbness in the feet when the calves were swollen.  Physical exam showed normal gait and lower extremity muscle strength.  Knee ROM was normal (0-140 degrees) with a loose patella bilaterally, and no additional limitation on repetition.  Motor, reflex, and sensory exams of the legs were normal.  Bone scan dated, 20 December 2004, showed “bilateral shin splints and stress reactive degenerative changes” with no stress fractures on plain X-rays.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the left lower leg and the right lower leg conditions under a single disability rating, coded 5399-5312 (group XII – muscle function), citing rated as slight muscle injury.  VASRD §4.73 does not permit combined ratings of muscle that are not on the same side and anatomical region.  If the members judge that separately ratable conditions for each leg are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  The VA rated the exertional compartment syndrome conditions for the left leg and the right leg, each at 10%, coded 5010-5022 (arthritis, due to trauma - periostitis), based on the C&P examination 7 months after separation, citing degenerative changes on bone scan and evidence of bilateral painful, limited motion of both legs.  

In this case a bilateral lower extremity condition was determined to fail retention standards, was profiled, and was implicated by the commander’s statement.  Members thus agreed that each lower extremity should be conceded as separately unfitting; and, that coding and rating features were logically identical.  

The panel considered rating each leg exertional compartment syndrome analogous to a muscle injury (same coding as the PEB) IAW VASRD §4.73 (schedule of ratings—muscle injuries), §4.55, and §4.56.  There were consistent complaint of one or more of the cardinal signs and symptoms of muscle disability particularly lowered threshold of fatigue or fatigue pain after each lower leg compartment and limiting standing over 30 minutes, running, jumping and marching.  There was also some evidence of inability to keep up with work requirements of fitness testing and ruck marching.  The panel agreed that the CI’s symptoms more nearly approximated the disability picture for a moderate muscle disability warranting a 10% rating for each leg.  There was no evidence of tibial impairment or knee or ankle disability that would rate higher than 10% for either leg IAW VASRD §4.71a.  

After due deliberation, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right chronic exertional compartment syndrome condition and a 10% rating for the left chronic exertional compartment syndrome condition, each coded 5399-5312.  

BOARD FINDINGS:  In the matter of the bilateral chronic exertional compartment syndrome condition, the panel unanimously recommends that each lower extremity be separately adjudicated as follows:  an unfitting right exertional compartment syndrome condition coded 5399-5312 and rated 10%, and an unfitting left exertional compartment syndrome condition, coded 5399-5312 and rated 10%, both IAW VASRD §4.73.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Bilateral Chronic Exertional Compartment Syndrome	Left	5399-5312	10%	
	Right	5399-5312	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007541, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure