RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02282
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Attack Helicopter Repairer and Cavalry Scout, medically separated for “chronic bilateral leg pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration 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 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 - 20060327	VARD - 20060915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Leg pain	5099-5003	10%	Compartment Syndrome, Right Lower Extremity	8723	10%	20060622	
			Compartment Syndrome, Left Lower Extremity	8723	10%	20060622	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  Bilateral Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg condition began in 2001 while running on uneven ground during training.  The MEB forwarded “bilateral leg pain” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated February 2006, 2 months prior to separation, the CI reported bilateral intermittent intense, sharp, crampy leg pain since 2001.  The CI stated that the leg pain is associated with running, fast walking, climbing stairs or hills or standing for prolonged periods of time.  The examiner referenced a nuclear medicine bone scan performed in December 2005 that showed nonspecific stress related changes versus posttraumatic changes of the right patella and both 1st metatarsophalangeal joints.  No physical examination was documented on the DD Forms 2807 and 2808.  The MEB NARSUM examination on 27 February 2006, 2 months prior to separation, noted complaints of recurrent bilateral leg pain whose onset occurred while running on uneven ground during a training exercise in 2001.  The CI stated that the leg pain is relieved with approximately 15 - 20 minutes of rest and stretching.  The examiner noted that the CI’s ongoing pain is “difficult to distinguish from exertional compartment syndrome.”  The CI did not want any type of surgery.  Physical examination showed there was full range of motion (ROM) about the knee and ankle with 5/5 motor strength.  Radiographs on 22 November 2005 demonstrated no evidence of fracture, dislocation, or significant bone abnormality except for a very mild convexity anteriorly on the right tibia diaphysis.  At the 22 June 2006 VA Compensation and Pension (C&P) evaluation, performed 1 months after separation, the CI complained of bilateral compartment syndrome.  He stated that “while he was in service that he would eventually need a fasciotomy for relief of this.”  The CI was not interested in a fasciotomy at the time.  The CI stated that he continued to have problems if he stood on his feet for longer than 20 minutes and had pain with all calf motion, but predominantly in the anterior and lateral compartments.  He further stated that if the condition gets “really bad, then he gets numbness and tingling in the webbing of his first toe bilaterally”.  The CI admitted that he did not use any assisted devices for ambulation.  Physical examination showed that repetitive flexion, inversion and eversion of the feet, bilaterally, produced complaints of increase in pain with tightness in the anterior and lateral compartments of his legs.  The pain was reproducible by palpation and did not dissipate for five minutes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg pain condition under a single Service disability rating of 10%, coded 5099-5003 (Arthritis, degenerative), and citing slight or constant chronic pain without consistent evidence of compartment syndrome or other etiology  The VA rated the compartment syndrome condition 10 % for each leg, coded 8723.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant with the 5003 combined rating criteria, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed member consensus was therefore that each leg is separately unfitting and that identical coding and ratings are applicable.  Chronic exertional compartment syndrome (CECS) is a condition in which the pressure in the muscles increase to extreme levels during exercise.  The symptoms are a sensation of extreme tightness in the affected muscles followed by a burning sensation if exercise is continued.  In the leg, CECS, usually occurs in the anterior compartment, however it is also seen in the lateral compartment of the leg.  The compartments of the leg do not communicate with each other, therefore the anterior and lateral compartments are not confluent as well as there is no confluency of compartments in opposing legs.  At the MEB NARSUM examination on 27 February 2006, 2 months prior to separation, the CI reported that the pain was relieved with approximately 15 - 20 minutes of rest and stretching.  The CI declined any surgery for the leg pain condition at that time.  The CI complained on several occasions of tightness in both legs with the anterior and lateral compartments when exercising, running, walking or climbing stairs which was also supported by a ROM examination which elicited calf pain, specifically cited on the C & P examination performed in June 2006, 1 month after separation.  Board members agreed that the subjective reports of pain with use and objective findings of reproduction of pain with repetitive motion met criteria for a 10% rating for each leg.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends disability ratings of 10% for each leg pain conditions, and coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic right leg pain condition, the Board unanimously or majority determined that it was unfitting and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the chronic left leg pain condition, the Board unanimously or majority determined that it was unfitting and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	
Chronic Right Leg Pain	5099-5003	10%	
Chronic Left Leg Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150823, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004224, XXXXXXXXXXXXXXXXXX

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,