RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01718
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “right lower extremity compartment syndrome” with a disability rating of 10%.  

CI CONTENTION:  “Review all 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 - 20081010	VARD – 20090502 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lower Extremity Compartment Syndrome	5399-5312	10%	Right Anterior Shin Splint; and Right Anterior Tendonitis, S/P Compartment Syndrome	5399-5312	10%	20080703	
Bilateral Knee Retropatellar Pain Syndrome	Not Unfitting	Right Knee Patellofemoral Pain Syndrome	5024-5260	10%	20080723	
		Left Knee Patellofemoral Pain Syndrome	5260	0%	20080723	
Right Ankle Impingement	Not Unfitting	Right Ankle Condition	5299-5271	NSC	20080723	
Lichen Nitidus	Not Unfitting	Lichen Nitidus	7899-7822	NSC	20080723	
Idiopathic Hypersomnia	Not Unfitting	Sleep Apnea Syndromes	6847	NSC	STR	
Bilateral Plantar Fasciitis	Not Unfitting	Bilateral Plantar Fasciitis	5024-5276	NSC	20080723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Lower Extremity Compartment Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right leg anterior and lateral compartment fasciotomy on 27 September 2004 to relieve right leg pain and intermittent numbness of 6 months duration. Although the CI noted a slight improvement after surgery, he continued to have persistent pain in his right leg, despite physical therapy and rehabilitation efforts.  

The 2 March 2007 MEB NARSUM examination, 23 months prior to separation, noted the complaint of right leg pain.  Physical examination showed a 4 cm incision over the lateral aspect of the distal leg for the anterolateral fasciotomy.  The CI had intact sensation over the dorsum and plantar aspects of the foot.  There was mild tenderness around the incision consistent with scar tissue formation.  There was no bulging of the muscle belly laterally with plantar and dorsiflexion of the foot.  Examination of the ankle showed a negative anterior drawer and negative tilt test.  He had tenderness over the anterolateral and anteromedial soft spots and had slightly decreased ankle strength on the right compared to the left.  There was no tenderness along the anterior medial or posterior lateral tibia.  X-rays of the right leg dated 14 June 2007 were normal.  

At the primary care clinic appointment on 19 February 2008, 12 months prior to separation, the CI noted his right lower leg hurt as did the side of his right foot.  The impression of tendonitis of the right anterior tibia was made and treatment consisted of ice to the lower extremity and stretching.  Physical therapy was carried out; however, on 15 April 2008 the CI had unbearable pain after 3 minutes while wearing a rucksack and marching on a treadmill.  

At the 3 July 2008 VA C&P examination, 7 months before separation, the CI reported pain with precipitating or aggravating factors of prolonged standing and walking.  Physical examination showed normal posture and gait without any ambulatory aids.  The right ankle was normal in appearance with range of motion (ROM) of dorsiflexion 20 degrees (normal 20) and plantar flexion 45 degrees (normal 45).  The right knee was normal in appearance with flexion 140 degrees (normal 140) and extension 0 degrees (normal 0).  There was bilateral mid-superior tibia tenderness to deep palpation.  

At the 8 September 2008 physical therapy ROM study, 5 months prior to separation, right ankle dorsiflexion “lacked 5 degrees from neutral” with pain on motion and right ankle plantar flexion was 50 degrees without pain.  Right knee flexion was limited to 120 degrees with pain starting at 100 degrees and extension was 0 degrees without pain on motion.  

The 9 September 2008 MEB NARSUM addendum, 5 months prior to separation, noted complaints of right lower extremity compartment syndrome with pain status post fasciotomy.  The CI noted he reinjured the leg by repeated trauma in 2005.  Physical examination showed tenderness of the right knee and right shin areas and the right ankle.  The examiner noted no acute ROM difficulties.  A bone scan to include the distal legs dated 12 November 2008, 3 months prior to separation, demonstrated bilateral focal uptake, more pronounced on the right side in the region of the calcaneocuboid or calcaneonavicular area with negative vascular and tissue phases, that may have represented a tarsal coalition or less likely aseptic necrosis or posttraumatic changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right lower extremity condition 10%, coded 5399-5312 (analogous to muscle group XII injury moderate), citing moderate disability due to fatigue, pain, and loss of endurance.  The VA also rated the right lower extremity condition 10%, coded 5399-5312, based on the C&P examination.  Panel members noted the CI had residual pain in the right lower extremity status post a fasciotomy for treatment of the compartment syndrome, and he also had symptoms of shin splints which were not confirmed by a bone scan.  Although dorsiflexion was reported to be normal in some examinations, at the physical therapy examination 5 months prior to separation the CI “lacked 5 degrees from neutral;” however, plantar flexion was 50 degrees.  Therefore, there is insufficient evidence to support a moderately severe injury using code 5312.  Members then considered code 5262 (tibia and fibula, impairment of); however, there was insufficient evidence to support a moderate knee or ankle disability.  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 the right lower extremity compartment condition.  

Contended PEB Conditions:  Bilateral Knee Retropatellar Pain Syndrome, Right Ankle Impingement, Lichen Nitidus, Idiopathic Hypersomnia, and Bilateral Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The retropatellar pain syndrome and ankle pain were profiled, but were not implicated in the commander’s statement.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right lower extremity condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee retropatellar pain syndrome, right ankle impingement, lichen nitidus, idiopathic hypersomnia, and bilateral plantar fasciitis conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008170, 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