RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00919
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fire Support Specialist, medically separated for “chronic right leg pain status post 4-compartment fasciotomy for external compartment syndrome” with a disability rating of 0%.  

CI CONTENTION:  The CI contends the additional unfitting conditions of “PTSD, right knee [and] lower back.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20050301	VARD - 20050615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Leg Pain…	5099-5003	0%	S/P Right Distal Lower Extremity Fasciotomy	5312	10%	20050120	
			Surgical Scars, Right Lower Leg	7801	0%	20050120	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Right Leg Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a diagnostic arthroscopy of the right knee on 20 January 2004, which was essentially normal.  On 18 February 2004, the CI underwent surgical release of exercise induced compartment syndrome.  The post-operative course was complicated by wound dehiscence (opening of the sutures prematurely), but otherwise the symptoms improved.  In physical therapy on 2 April 2004, the CI was noted to have some persistent pain, but bone scan was normal.  Dorsiflexion (toes up) of the right ankle was reduced to 0 degrees compared to 10 degrees on the left (20 is normal).  During the 30 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported right leg pain.  The physical examination showed post-surgical scars, but other pathology was not documented.  

The 30 December 2004 MEB NARSUM examination, 4 months before separation, noted complaints of pain and swelling with minimal improvement following surgery.  On physical examination, the gait was slightly antalgic (abnormal due to pain) favoring the right leg.  The scars were well healed although tethered to the underlying tissue.  The ROM of the knee was symmetric at 0-130 degrees bilaterally and without recorded pain.  Sensation and strength were normal and atrophy not documented.  The ROM of the ankles showed symmetric dorsiflexion at 10 degrees bilaterally and plantar flexion (toes down) of 25 degrees on the right and 32 degrees on the left (normal 45).  The limitation was from pain.  Tenderness and swelling of the lower extremity were present.  

At the 20 January 2005 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported difficulty walking, but stated that he was able to garden and push a lawnmower.  The physical examination showed a normal gait without the use of an assistive device.  The scars were well healed and non-adherent.  There was no swelling.  Discoloration (other than the scars) was not present.  The ROM of the knees and ankles was full and pain free; there was no additional limitation with repetition.  The neurological examination was normal and X-rays of the lower leg were also normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy rated as minimal and occasional.  The VA rated the right leg condition 10%, coded 5312 (Muscle Group XII.  Function: Dorsiflexion), based on the C&P examination 3 months before separation, citing moderate residual disability following injury and surgery to musculature of the right anterior lower leg, with evidence of fascial injury, post-surgical wound complication, and chronic residual fatigue-pain.  

The panel considered the evidence. muscles of the calf.  The CI was noted to have reduced plantar flexion and an abnormal gait on the NARSUM, but both were normal on the C&P evaluation.  Although the VA examination was only 1 month after the NARSUM examination, it was nonetheless both closer to separation and further from surgery and therefore assigned a higher probative value for rating purposes.  The panel noted that the code 5311 (Group XI muscles) included plantar flexion of the foot and was thought to be a better description of the condition, but supported no higher than a slight impairment with normal strength, gait, and full, pain free ROM.  This would rate at 0% as well, providing no advantage to the CI.  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 chronic right leg condition.  

BOARD FINDINGS:  In the matter of the chronic right leg condition and IAW VASRD §4.71a and §4.73, the panel unanimously recommends no change in the PEB adjudication.  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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004839, 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