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DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON  NAVY  YARD  DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
12 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01074

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 4 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for_appropriate action.

2.	On 31 January 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01074 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080229

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Recruiter, medically separated for “neuropathic pain left lower extremity [LLE]” and “neuropathic pain right lower extremity [RLE],” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  Review the leg conditions.  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 - 20080104	VARD - 20090416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuropathic Pain LLE	8599-8520	10%	LLE Neuropathic Fasciotomy	8599-8520	10%	20090226	
Neuropathic Pain RLE	8599-8520	10%	RLE Neuropathic Fasciotomy	8599-8520	10%	20090226	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Neuropathic Pain LLE and Neuropathic Pain RLE. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent bilateral anterior and lateral lower compartment leg releases (fasciotomies) in November 2002 and subsequently underwent additional procedures on the lower extremities using the medial approach to release his deep and superficial posterior compartments in March 2005. He noted symptoms of increasing pain thereafter, which were exacerbated in December 2006 after playing football. He was treated with baclofen (muscle relaxer).      He was evaluated in the pain clinic on 18 June 2007 where he

was diagnosed with neuropathic pain of the bilateral lower extremities and treated with Lyrica (pregabalin for pain). The examiner noted the CI reported occasional temperature and color changes, but no sudomotor (sweating) edema or allodynia (pain from stimuli that normally does not cause pain). Treatment with Lyrica and baclofen provided some relief, although his pain returned to its regular state. The pain management specialist recommended the CI be given tramadol (an opioid-like medication) and ibuprofen (a nonsteroidal anti-inflammatory drug) and started him on nortriptyline at bedtime, while the Lyrica was continued. A neurologist performed electrodiagnostic tests, which ruled out complex regional pain syndrome. An MRI of the spine showed a small disk protrusion and degenerative changes at L4-5 with mild spinal stenosis, which did not suggest a spinal etiology. However, a definitive cause of the CI’s pain was not determined.

During the 30 October 2007 MEB NARSUM examination, 4 months prior to separation, the CI complained of pain in both lower limbs. Physical examination showed well-healed scar formation on both his medial and lateral lower extremities. He had pain on his calf with gentle compression. There were no motor abnormalities. Sensory defects were difficult to ascertain, but it seemed like the superficial peroneal, deep peroneal, saphenous, and tibial nerves were intact. Ankle and patellar tendon reflexes were present bilaterally and hip and knee motions were normal. His ankle plantar flexion and dorsiflexion had about a 40 degree arc, which was somewhat limited and he had pain with inversion and eversion. The 7 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, revealed decreased strength and decreased sensation to light touch of the lower extremities.   X-rays of the lumbar spine on      25 November 2008 were normal.

At the 26 February 2009 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported bilateral leg pain that was sharp, agonizing, intermittent, throbbing and burning. He also had the sensation of pins and needles in both legs (medial portion and calf areas) with occasional calf stiffness. He denied any sensory loss or motor symptoms (weakness), bowel or bladder involvement or erectile dysfunction. He did not use any kind of brace, support, orthoses or assistive device for ambulation. Physical examination showed normal motor strength and no allodynia or hyperesthesia. Gait was antalgic, but stable. There were no lower extremity abnormalities noted and the peripheral pulses were normal. The examiner’s assessment was post compartment syndrome with neuropathic pain of both lower extremities, but he did not believe the CI had sympathetically mediated pain nor did he have a picture of complex regional pain syndrome.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the LLE neuropathy 10% and the RLE neuropathy 10%, each analogously coded 8520 (mild sciatic nerve paralysis). The VA also rated the LLE neuropathy 10% and RLE neuropathy 10%, each analogously coded 8520, based on the C&P examination, citing mild incomplete paralysis below the knee.

Panel members noted that although the CI had bilateral pain in the lower extremities of an uncertain etiology, there was insufficient evidence to support a higher rating for either a moderate or moderately severe rating since he had normal strength and normal electrodiagnostic studies, albeit he took several medications for the pain. After due deliberation, considering all 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 either the LLE neuropathy or the RLE neuropathy conditions.

BOARD FINDINGS: In the matter of the LLE neuropathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the RLE neuropathy and IAW VASRD §4.124a, the panel 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.