RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02205
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “four compartment disease (exercise induced compartment syndrome),” rated 10% for the left leg and 10% for the right leg, with a combined disability rating of 20%.  

CI CONTENTION:  He has permanent disability in his legs and requested review of conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20070629	VARD - 20090206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Four Compartment Disease, Left Leg 	5399 5312 	10%	Neuralgia (Compartment Syndrome) Lower Left Extremity 	8722	10%	20080724	
Four Compartment Disease, Right Leg	5399-5312	10%	Neuralgia (Compartment Syndrome) Lower Right Extremity	8722	10%	20080724	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Bilateral leg pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral leg condition began in August 2006 after running long distance.  Within 6 months, his condition progressed to the point that his leg symptoms of pain and numbness came on after short distance running.  In March 2007, orthopedics diagnosed the CI with bilateral lower extremity exertional compartment syndrome.  He was not a surgical candidate.  Secondary to persistent symptoms and permanent physical restrictions, he was referred to a MEB.  

At the 12 June 2007 MEB NARSUM examination, 2 months prior to separation, the CI’s chief complaint was “bilateral leg pain associated with numbness.”  The pain was in both lower legs and the numbness in his feet.  His physical examination (PE) revealed post-exercise reproduction of pain and muscle tension to both lower legs; although neurological and vascular function of the same remained normal.  Range of motion of both knees and ankles were decreased, but near equivalent in right/left side comparison.  

At the 24 July 2008 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported pain in both legs, with tingling and numbness in his feet with just 5 minutes of increased activity…specifically mentioned was “playing basketball.”  The PE of the bilateral lower extremities revealed no obvious deformities and no areas of tenderness, edema, or altered sensation.  The CI ambulated without any assistive devices and his gait was normal.  Both Achilles reflexes were diminished, but equal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left leg conditions 10% each, analogously coded 5399 5312 (muscle group XII), citing moderate impairment for each leg.  The VA also rated the left and right leg conditions 10% each, coded 8722 (neuralgia; superficial peroneal nerve), based on the C&P examination, citing incomplete paralysis of left and right foot movements which were moderate.  Panel members first agreed that the greater probative value be apportioned to the NARSUM examination due to its close 2 month proximity to separation.  

While the CI’s disability is not specifically listed in the VASRD rating schedule, the PEB’s coding approach and rating remained consistent with the CI’s clinical history of adverse muscle activity and thus §4.73 standards.  The VA’s coding approach under §4.124a was also considered and would be reasonable if there was objective clinical evidence specifically indicating a peripheral nerve or known anatomical distribution of sensory loss.  However, given the normal neurological function of both lower extremities in the probative examination, there was little support for rating under VASRD §4.124a criteria.  The predominant symptoms involving muscular tissue warranted rating under VASRD §4.73 standards involving muscle group XII.  Panel members agreed that the degree of impairment in this case was above the description of “slight” impairment and below any level of “severe” impairment.  Therefore, 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 and left leg conditions.   

BOARD FINDINGS:  In the matter of the right and left leg conditions and IAW VASRD §4.73, 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170330, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180015066, 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