RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02166
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20090413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Equipment Operator, medically separated for “gunshot wound, left lower extremity, with minimal soft tissue loss, status post split-thickness skin graft, healed” and “residual sensory loss, dorsal aspect of foot, and anterior distal third, left leg,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  The 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 - 20081110	VARD - 20140715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Gunshot Wound, Left Lower Extremity, with Minimal Soft Tissue Loss, Status Post Split-Thickness Skin Graft, Healed	5312	10%	Residuals, Gunshot Wound Left Leg, Muscle Group XII	5312	10%	20140612	
			Residual Scars, Gunshot Wound, Left Anterior Thigh	7801	20%		
			Residual Scar, Left Anterior Thigh, Secondary to Skin Graft Harvest Site	7802	0%		
			Left Hip Condition, Associated with Residuals, Gunshot Wound…	5251	NSC		
			Left Knee Condition, associated with Residuals, Gunshot Wound…	5257	NSC		
Residual Sensory Loss, Dorsal Aspect of Foot, and Anterior Distal Third, Left Leg	8622	10%	Traumatic Left Superficial Peroneal Neuropathy, with Left
Foot Numbness	8526	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Gunshot Wound Left Lower Extremity.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left lower extremity condition began in April 2006 after the CI underwent debridement and grafting for a gunshot wound injury to the left lower leg.  Post-operatively the CI continued to report left leg pain, numbness, and weakness.

The 10 May 2008 MEB Orthopedic, 11 months prior to separation, showed decreased left foot dorsiflexion strength of 3/5 compared to 5/5 dorsiflexion on the right side.  There was no evidence of inflammatory changes or infection.  The thigh skin graft was healed.

During the 02 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported left lower leg pain.  He had trouble standing for a long time, walking more than one-half mile and could not run.  Physical examination showed a gunshot wound healing scar with decreased dorsiflexion and sensation distal to the scar.  The CI exhibited an unsteady tandem gait upon ambulation.  The examiner annotated gunshot wound with a scar to the left lower extremity and sensory defect to the left lower extremity.

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left lower extremity condition 10%, coded 5312 (Muscle Group XII, foot and leg).  The evidence did not support moderately severe muscle injury as defined by VASRD §4.56 of prolonged infection, loss of deep fascia, and loss of dorsiflexion or extension for a 20% rating under 5312.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left lower extremity gunshot wound condition.

Residual Sensory Loss Left Foot and Leg.  According to STR and MEB NARSUM, the CI’s sensory loss condition began in April 2006.  During the 10 May 2008 MEB NARSUM examination the CI reported complaints of residual numbness and tingling in the anterior portion of the distal third of the leg (front above ankle) and dorsum (top) of the foot.  The CI stated that he was unable to run because he experienced pain in the leg with heel strike.  Physical examination showed loss of sensation in the area of the superficial peroneal nerve anteriorly and on the front of the foot.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left lower extremity sensory loss condition 10%, coded 8622 (musculocutaneous nerve [superficial peroneal] neuritis).  There was no evidence of severe nerve damage (decreased or absent foot eversion, abnormal gait due to sensory loss) for a 20% rating.  There was no evidence of sensory loss resulting in difficulty ambulating to support a rating for severe incomplete nerve paralysis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left lower extremity sensory loss condition.

BOARD FINDINGS:  In the matter of the gunshot wound, left lower extremity, with minimal soft tissue loss, status-post split-thickness skin graft, healed condition and IAW VASRD §4.73, the panel unanimously or majority recommends no change in the PEB adjudication.  In the matter of the residual sensory loss, dorsal aspect of foot, and anterior distal third, left leg condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150807, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX

		- XXXXXXXXXXXXXXXXXX former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
	
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	     				  Acting