RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01407
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20040817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Electricians Mate, medically separated for “saphenous nerve paresthesias, right” with a disability rating of 10%.

CI CONTENTION:  “Was doing way better with my legs until I had all the surgical procedures.  Been taking pain medication for the most part.  A nail or screw attached to rod in my right leg seem be coming out of my right [leg].”  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 - 20040428	VARD - 20041020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Saphenous Nerve Paresthesias	8726	10%	Right Leg Saphenous Nerve Paresthesia	8727	10%	20040630	
Activity Related Pain Right Tibia	Cat II	Residuals, Surgery of the Right Tibia	5262	20%	20040630	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Saphenous Nerve Paresthesias.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a right tibial osteotomy with placement of hardware (attempt to lengthen the bone) in February 2003 to correct a leg length discrepancy.  He experienced right foot pain and new numbness to the bottom of the foot with attempted ambulation after the operation.  He underwent a second procedure in October 2003 for removal of hardware, open reduction and internal fixation of the tibial nonunion with an intramedullary nail and fibular osteotomy.
The 19 March 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of right lower leg pain with activity and decreased sensation over the lateral aspect of the of the knee.  Physical examination showed equal leg lengths while standing and a level pelvis.  Sensation was intact to light touch over the medial and lateral aspects of the plantar surface of the foot and the first web space on the dorsum of the foot.  There was diminished light touch of the region of the medial ankle that the examiner noted was consistent with irritation of the saphenous nerve.  The examiner, who was also the operating surgeon, reviewed X-rays and noted uncomplicated union of the surgical area.  The 8 April 2004 physical therapy evaluation showed knee flexion and extension to be full and right ankle dorsiflexion and plantar flexion to be 75% of normal.  

At the 30 June 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported intermittent right lower leg pain with standing.  He also complained of loss of feeling on the plantar aspect of the right foot that led to him cutting his foot on one occasion without noticing.  Physical examination showed “a slight limp” favoring the right leg.  Leg length measurements from the anterosuperior iliac spine to the medial malleoli were 94 cm on the left and 92 cm on the right.  Examination of the ankles showed symmetrical range of motion (ROM) with the unaffected side, without pain, weakness or lack of endurance.  There was no tenderness about the ankle.  Sensory examination revealed decreased sensation of the right plantar aspect of the foot.  X-rays of the right knee performed in conjunction with the C&P evaluation showed the proximal end of the intramedullary rod in place in the tibia that was held in position with an orthopedically-placed transverse screw.  X-rays of the right ankle demonstrated the distal tip of the same rod and an old healed fracture of the distal right tibia and fibula noted with no evidence of nonunion or malunion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg saphenous nerve condition 10%, coded 8726 (femoral nerve neuralgia).  The PEB adjudicated the activity related pain of the right tibia as a related Category II condition that contributed to the disability in this case.  The panel agreed the right tibia pain and disability were not related to the saphenous nerve paresthesias and would not violate the principals of VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  As such, the panel recommends a separate disability rating for the right tibia condition.  The VA also rated the right leg saphenous nerve condition 10%, coded 8727 (saphenous nerve neuralgia), based on the C&P examination 2 months before separation, citing objective evidence of pain, limitation of motion and numbness.  The VA rated the right tibia pain 20%, coded 5262 (tibia and fibula, impairment of, malunion of with moderate knee or ankle disability), citing malunion of the tibia and fibula.

The panel noted the highest rating for severe to complete paralysis of the saphenous nerve is 10% coded 8727 (neuralgia).  There was no evidence of injury or paralysis of the femoral nerve to justify a rating under codes 8526, 8626 or 8726.  There are no other applicable codes.  With respect to the right tibia pain, there was no evidence of fracture with nonunion or malunion with knee or ankle disability to justify a rating higher than 0% under code 5262 (tibia and fibula, impairment), as recorded by VA X-rays proximate to separation.  There are no other codes that apply to the tibia.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separate disability rating of 0% for the right tibia pain condition, coded 5262.  This provides no rating advantage to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right saphenous nerve paresthesias nor right tibia pain.

BOARD FINDINGS:  In the matter of the right saphenous nerve paresthesias and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right tibia pain and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20161008, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN