RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00351
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20071130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, LAV Crewman, medically separated for “right anterior and lateral calf fascial herniation” with a disability rating of 10%.   

CI CONTENTION:  The CI made no specific contention.  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 - 20071003	VARD - 20081230	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Anterior and Lateral Calf Fascial Herniation	5312	10%	Residuals Right Anterior/ Lateral Calf Fascial Herniation with Associated Paresthesias and Medial Tibial Stress Syndrome				
Paresthesias RLE	Cat II		5312	10%	20081117	
Right Medial Tibial Stress Changes with Medial Tibial Stress Syndrome	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Anterior and Lateral Calf Fascial Herniation.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was thrown from his vehicle following an IED (improvised explosive device) explosion and injured his right lower extremity on 4 October 2006.  He also sustained a chest contusion (bruise) and laceration to the head.  He was admitted for observation and elevation of the right lower extremity (RLE).  Following redeployment, he noted persistent pain in the RLE.  A bone scan was accomplished on 30 July 2007 to evaluate for a possible stress fracture.  This was not present but stress changes were seen in the right anterior tibia.  The CI was not able to meet full duty requirements despite rehabilitation and was referred for an MEB.  

The 20 August 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued pain and inability to run, climb or return to full activities of a Marine.  Physical examination showed normal pulses, but obvious fascial herniation of the anterior lateral musculature of his calf.  There was tenderness to palpation over his shin which was unchanged (from prior examinations).  There was full range of motion (ROM) of his knee, hip and ankle.  There were paresthesias (abnormal sensations) in the right lateral three toes on the dorsal surface.  The motor function was normal.  During the September 2007 MEB examination (recorded on DD Forms 2807 and 2808) 2 months prior to separation, the CI reported that his right foot three toes went numb at random times.  On physical examination, RLE weakness and palpable muscle deformity were recorded.  

At the 17 November 2008 VA Compensation and Pension (C&P) evaluation, just under 12 months after separation, the CI reported he was hit by an IED and thrown from the vehicle.  The CI reported blunt trauma to his leg, but there was not penetration of the skin (blunt trauma only).  He continued to have pain, but was no longer receiving treatment.  He was working as a prison guard and reported limitations in his job and the activities of daily living.  These were not specified though.  The CI reported bulging over the lateral tibia when he dorsiflexed (toes up) his foot and tingling if he stood for more than an hour.  The CI denied any flare-ups.  The physical examination showed a normal appearing right leg without redness, swelling, or atrophy.  There was mild tenderness on palpation.  When the CI dorsiflexed his right ankle, there was an abnormal bulge of the anterior compartment muscles at the lateral side of the shin.  On plantar flexion, the CI reported pain in the anterior compartment.  The ROM of the right ankle was dorsiflexion 20 degrees (20 normal) and plantar flexion (toes down) of 25 degrees (normal 45 degrees).  The ROM of the knee was normal.  There was no objective evidence of painful motion, abnormal movement or guarding.  The gait was normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right anterior and lateral calf fascial herniation condition 10%, coded 5312 (group XII, muscle injuries).  The PEB also determined paresthesias of the right lower extremity and right medial tibial stress changes with medial tibial stress syndrome to be related category 2 conditions.  The VA based its rating on the C&P examination almost 12 months after separation, citing moderate muscle disability.  The panel first considered if the two Category II conditions were separately unfitting.  Multiple examinations documented the presence of a fascial defect with secondary limitations in activity (due to pain).  The paresthesias were a subjective complaint and were not shown to result in an additional limitation in duty.  The stress changes were found on the bone scan and were consistent with the underlying injury rather than a separate problem.  The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The panel then considered if the overall disability rose to a moderately severe level which would support a higher 20% rating.  The motor function was recorded as normal as was the gait; an impairment of no higher than moderate is warranted with this level of function.  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 right anterior and lateral calf fascial herniation condition.  

BOARD FINDINGS:  In the matter of the right anterior and lateral calf fascial herniation condition and IAW VASRD §4.73, 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 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 20160524, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN