RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00232
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070322

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E1, Trainee, medically separated for “bilateral exercise-induced compartment syndrome mild,” with a disability rating of 10%.

CI CONTENTION:  The CI contends the condition continues to worsen.  The 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 - 20070112	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Exercise-Induced Compartment Syndrome Mild	5399-5312	10%	No VA Examination within 12 month period of consideration	
Bilateral Shin Splints	CAT II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Exercise-Induced Compartment Syndrome Mild.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral shin splints condition began in July 2006 during Basic Training.  

During the December 2006, MEB examination (recorded on DD Forms 2807 and 2808) 3 months prior to separation, the CI reported she had been advised to have surgery to repair the compartment syndrome in both legs.

Physical examination of the lower extremities was deferred to orthopedic.

The 5 December 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain in both anterior shins that was worse with running and prolonged walking.  She occasionally had a sensation of numbness in the mid-leg and calf, without radiation.

Physical examination showed “full” range of motion (ROM) of both knees and ankle, and bilateral tenderness over the mid shins to the distal 1/3 of the tibia.  On post-exercise examination, the CI had pain in the shins but the compartments were non-tender to palpation.  Pain was absent with muscle stretches.  Radiographs (x-rays) and bone scan of the legs were normal   The examiner noted the CI had refused surgery and opined the refusal was reasonable given the bilateral release surgery would not have likely relieved the pain from the shin splints.

The panel directed attention to its rating recommendation based on the above evidence. 

The PEB rated the bilateral compartment syndrome at 10%, coded 5399-5312 (muscle group Xll).  The PEB adjudicated the condition as mild.  The 10% rating under this code is consistent with moderate disability.

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 the panel must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for service rating.  If the members judge that separately ratable conditions 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.  Notes in the record in evidence were silent in regards to 1 extremity being more symptomatic than the other with the exception of the 6 November 2006 electro-diagnostic studies report.  The report noted the CI reported that her symptoms were more prominent on the left leg than the right.   

Commander’s statement (CS) stated the CI’s condition had rendered her incapable of performing her duties.  There was no indication that one leg was worse than the other.  Panel members agreed, each extremity was separately unfitting and then proceeded to the rating of the left lower extremity.  

Bone scans and nerve conduction studies were negative.  The record demonstrated that the CI reported periods of left leg numbness and was referred to neurology for evaluation of the left lower extremity.  Neurology noted her right leg had not been identified problematic, and therefore, electro-diagnostic studies of the right leg were not indicated.  She was placed on quarters 3 times due to leg numbness.  The CI reported pain with running and prolonged walking, and pain on motion post-exercise NARSUM, was present in the shin.  The record documented no episodes of swelling, giving way, or loss of function.  Left extremity ROM recordings were normal at the NARSUM.

After deliberating, the panel agreed the left extremity condition justified the 10% level of disability under the 5312 code.

The panel then next considered the right extremity and concluded although there was documented shin pain, there was no decrease in ROM, painful motion or swelling, and no radiographic evidence of right leg pathology.  The right extremity was not compensable under any of the ROM codes, and the condition did not meet the requirement for compensation under §4.59 or §4.40; however, the STR supports the 0% rating under the 5312 code for slight disability.  The panel opined that the bilateral shin splints conditions were integral components of the bilateral compartment syndrome pathology and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).  Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right leg condition and 10% for the left leg condition.  As this result in no rating benefit to the CI, the panel recommends no change in the PEB adjudication for the bilateral exercise-induced compartment syndrome condition. 

BOARD FINDINGS:  In the matter of the bilateral exercise-induced compartment syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  

There are 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 20160419, 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, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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