RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01340
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “compartment syndrome, left leg,” with a disabiliy rating of 0%.

CI CONTENTION:  “Review 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 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 – 20060523	VARD – 20080229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Compartment Syndrome, Left Leg	5399-5312-8723	0%	Left Lower Extremity Exercise-Induced Compartment Syndrome	5299-5260	0%	20070811	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Leg Compartment Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left lateral leg pain and numbness while ruck marching or running began approximately 18 months prior to referral for an MEB.  The 7 January 2005 left tibia and fibula X-rays were normal.  At an 8 April 2005 orthopedic surgery evaluation, the CI reported a 4-month history of left leg pain and numbness with running greater than a half mile.  The physical examination, performed after 20 minutes of running on a treadmill, revealed a firm left calf.  Measurements with an intra-compartmental pressure monitor revealed lateral compartment pressure of 50 mmHg (normal 0-10 mmHg) and anterior compartment pressure of 42 mmHg (0-10 mmHg).  The assessment listed exercise-induced left leg anterior compartment syndrome (tissue pressure within closed muscle compartment exceeding blood perfusion pressure causing ischemia).  At the 9 December 2005 orthopedic surgery follow-up the CI complained of worsening left leg symptoms.  He reported onset of exercise-induced compartment syndrome within a quarter mile and a noticeable foot drop within half a mile.  The CI declined surgical intervention.  On 30 January 2006 physical therapy (PT) measured range of motion (ROM).  Pain-free left ankle ROM was plantar flexion of 50 (normal 50), dorsiflexion of 20 (20), inversion of 30 (35), and eversion of 15 (15) degrees.  The 25 April 2006 NARSUM, 3 months before separation, recounted the history and interventions.  The CI complained of left leg pain and numbness with running and associated loss of foot sensation and foot drop.  The CI did not experience significant improvement with activity modification or PT and declined surgery.  The physical examination documented a normal gait.  The extremities demonstrated full ROM and the calves were soft and revealed no swelling or tenderness.  The examiner reiterated the 7 January 2005 X-ray findings, 8 April 2005 intra-compartmental pressures, and 30 January 2006 left ankle ROM measurements by PT.  The diagnosis listed left leg compartment syndrome.  The 8 August 2007 left tibia and fibula X-rays showed normal bone density and no acute or remote injury.  

During the 11 August 2007 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported he avoided running and strenuous activities, had no left lower extremity pain, and had no limitation on any distance for walking.  He related “… approximately once a month his leg will flare-up for 10 minutes if he has been walking fast for a long distance, it then quickly returns to normal.”  The CI did not require a cane or a brace and took no medications.  The physical examination documented a normal gait.  The left lower extremity examination revealed soft compartments and no tenderness along the tibia and fibula.  The left knee examination revealed no ligamentous instability or meniscal pathology.  Pain-free knee ROM was flexion of 140 (140) and extension of 0 (0) degrees.  Pain-free ankle ROM was plantar flexion of 30 (45) and dorsiflexion of 20 (20) degrees.  There was no knee or ankle pain, or additional limitation of ROM, with repetitive testing.  Strength, sensation, pulses, and deep tendon reflexes were normal.  The examiner recounted the findings of the X-rays.  The assessment listed left lower extremity exercise-induced compartment syndrome.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5399-5312-8723 codes (rating by analogy-muscle Group XII function: dorsiflexion-anterior tibial nerve neuralgia) citing left leg compartment syndrome, rated as mild incomplete paralysis, IAW U.S. Army Physical Disability Agency Policy/Guidance Memorandum #12, dated 28 February 2005.  The VA assigned a 0% rating under an analogous 5260 code (leg, limitation of flexion of) based on the C&P examination 13 months after separation, citing left lower extremity exercise-induced compartment syndrome, compartment pressures confirmed diagnosis, surgical options discussed and declined, and non-compensable ROM.  

The Board agreed a 10% rating was not supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  There was no limitation of knee flexion (5260) and extension (5261) for consideration under these respective codes. There was no knee ankylosis, recurrent subluxation/lateral instability, dislocated meniscus, symptomatic removed meniscus, tibia and fibula nonunion/malunion, or genu recurvatum for consideration under these respective diagnostic codes (5256, 5257, 5258, 5259, 5262, and 5263).  There was no compensable limitation of ankle motion, ankylosis, subastragalar or tarsal joint ankylosis, os calcis or astragalus malunion, or excision of the astragalus for consideration under these respective diagnostic codes (5271 5270, 5272, and 5273).  Peripheral neuralgia is usually characterized by dull and intermittent pain of typical distribution so as to identify the nerve.  The neuralgia codes rate based on an assessment of functional impairment of the involved nerve expressed in terms of severity of paralysis.  Members agreed that findings did not approach mild incomplete paralysis, consistent with a 0% rating under 8723.  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 left leg compartment syndrome condition.  

BOARD FINDINGS:  In the matter of the left leg compartment syndrome condition and IAW VASRD §4.71a, 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 20150615, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005993, XXXXXXXXXXXXXXXXXX. 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,