RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00032
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “bilateral anterior compartment syndrome” with a disability rating of 0%.  

CI CONTENTION:  He does not agree with the 0% disability rating and his condition continues to negatively impact daily activities.  He also believes he should have been rated for PTSD and an equinus/foot deformity acquired on active duty.  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 - 20050817	VARD - 20050915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Anterior Compartment Syndrome	5399-5312-8723	0%	Compartment Syndrome, Left Lower Extremity	5312-8723	0%	STR	
			Compartment Syndrome, Right Lower Extremity	5312-8723	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Bilateral Anterior Compartment Syndrome.  The PEB combined the left and right anterior compartment syndrome conditions under a single disability rating, coded 5399-5312-8723 (analogous to neuralgia of the anterior tibial nerve (deep peroneal) impacting the group XII muscle group function) and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, with no need for separate fitness adjudications.  The panel’s initial charge is therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record, the CI’s bilateral anterior compartment syndrome condition began in 1999 with no reported trauma or injury and a marked worsening in October 2004.  He had pain with running, road marching, jumping or rucking; and developed numbness and tingling into the feet with a foot drop after prolonged activity.  He was not a surgical candidate, and despite conservative treatment, he could not perform his specialty duties.  

At the 4 January 2005 podiatry examination, 9 months prior to separation, the CI reported bilateral foot drop with running.  Physical examination showed normal gait and stance with the CI able to dorsiflex to neutral with knees extended and beyond neutral with knees flexed; plantar flexion was normal.  Ankle strength (in all planes), sensation and reflexes were also normal.  

At the 19 July 2005 MEB orthopedic examination, 2 months before separation, the CI reported bilateral leg pain with running.  Physical examination showed active bilateral knee range of motion (ROM) from 0-130 degrees (normal 0-140), and bilateral ankle ROM with dorsiflexion to 20 degrees (normal), and plantar flexion to 40 degrees (normal 45).  There was mild tenderness over the posteromedial aspect of the tibial diaphysis bilaterally.  Lower extremity strength was 5/5, sensation was intact to light touch at L1-S2, and normal dorsalis pedis and posterior tibial pulses were present bilaterally. There was no VA examination in evidence proximate to separation.  

The panel first considered whether the left leg condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Both legs were profiled, implicated in the MEB orthopedic examination, forwarded by the MEB and adjudicated as unfitting by the PEB; also, all STR notes referenced a bilateral condition.  Members agreed that the both the right and left leg conditions were reasonably justified as separately unfitting and met VASRD §4.71a criteria for separate ratings.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB bundled the left and right anterior compartment syndrome conditions and applied a single 0% rating coded 5399-5312-8723.  The VA rated the left and right anterior compartment syndrome conditions 0% each, both coded 5312-8723 (neuralgia of the anterior tibial nerve (deep peroneal) impacting the group XII muscle group function), based on the STR, and citing that a higher 10% was not met without evidence of moderate incomplete paralysis of foot movements.   In deliberating over the bilateral leg disability due to exertional compartment syndrome, members referred to VASRD § 4.55 (principles of combined ratings for muscle injuries) which states that “a muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions.”  Moreover, panel precedent requires that a functional impairment tied to fitness must support an additional recommendation for a peripheral nerve rating at separation.  There was no evidence of functional nerve impairment in this case, and thus the panel cannot support a recommendation for additional rating.  Members considered VASRD code 5312, and noted rating criteria are based on slight, moderate, moderately severe and severe muscle disabilities.  This rating scheme entails a judgment call regarding the severity of muscle disability.  A rigid assessment could require strength tests of 3/5 or worse to merit the moderate rating, while a more liberal rating could apply any objective motor impairment or atrophy as a threshold for the moderate designation.  In this case, the CI’s only impairment was due to pain as there were no motor deficiencies present at the time of separation.  Members agree that the impairment due to pain was no more than slight, did not result in curtailment of the CI’s military career, and thus did not meet criteria for a moderate disability.  While the panel concluded that each leg was separately unfitting, since neither is ratable above 0%, there is no advantage to the CI to unbundle and rate separately.  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 left and right lower leg pain condition.  

BOARD FINDINGS:  In the matter of the bilateral anterior compartment syndrome condition 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 20161211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003336, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure