RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03942
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Crane Operator, medically separated for “exercise induced compartment syndrome of left calf” with a disability rating of 0%.

CI CONTENTION:  No specific contention was made.  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 - 20050509	VARD - 20050930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Compartment Syndrome of the Left Calf	5399-5311-
8525	0%	Left Calf Compartment Syndrome	5260	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Exercise Induced Compartment Syndrome of the Left Calf.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left calf condition began approximately in October 2002 while running or road marching.  A note dated 18 November 2002 revealed a palpable half-inch mass while squatting.  X-rays dated 24 January 2003 were normal.  A primary care evaluation on 7 April 2004 revealed intact weight bearing with “full” knee and ankle flexion and extension.  Homan’s sign (to determine a deep vein thrombosis) was negative and left leg pulses were 2+.  At a physical therapy visit on 9 July 2004, there was a dime-sized non-tender muscle protrusion on the lateral left leg.  He reported decreased sensation in the medial and lateral foot.  The orthopedic evaluation on 27 August 2004, revealed a mildly tender mass of the left lower leg, but no tenderness over the medial and lateral tibia.  The examiner’s impression was a left lower extremity muscle herniation; however, he felt the CI was not a candidate for surgery.  

A bone scan dated 23 September 2004, revealed some mild increased uptake within the right lateral malleolus and left midfoot, which might have represented traumatic areas or mild stress overuse injuries.  The commander’s statement dated 22 March 2005 indicated the CI’s disability impacted performance with limitations of no running, rucking, prolonged standing over 15 minutes, and lifting or carrying over 100 pounds.  However, the CI’s duty performance was satisfactory and physical impairments did not prevent the CI from completing his military duties.

During the 29 March 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported chronic left leg pain and left calf muscle herniation.  Physical examination revealed no hip or knee tenderness and both had “full” range of motion.  The right calf measured 39.5 cm and the involved left calf was 41.5 cm and nontender.  The 1 April 2005 MEB narrative summary (NARSUM) examination noted the complaint of chronic left leg pain, which the CI rated as slight in intensity and constant in frequency.  Physical examination was performed as part of the aforementioned MEB examination.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left calf condition 0%, analogously coded 5399-5311-8525 (group XI muscle group-posterior tibial nerve incomplete paralysis), citing mild incomplete paralysis.  The VA rated the left calf condition 10%, coded 5260 (leg, limitation of flexion), based on the STR, citing pain.  Although the CI had a left anterior leg muscle herniation with pain induced by exercise, the STR did not address leg compartment pressure readings.  The PEB dual coded the condition using code 5311 and a nerve code, which violates VASRD §4.55(a), which states “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.  Furthermore, code 5311 references the posterior and lateral crural muscles and muscles of the calf; however, the muscles of the anterior leg include the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius, which are group XII muscles (code 5312).

While the condition was quite limiting with running, it resolved rapidly thereafter; therefore, it is reasonable to be considered moderate using code 5399-5312 and rated 10% since there was no trauma, albeit at rest or not running it was slight, which with use of code 5399-5312 would rate 0%.  IAW VASRD §4.56 (evaluation of muscle disabilities) the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement.  However, there was no through and through or deep penetrating wound nor were there entrance and exit scars, loss of deep fascia or muscle substance.  Nevertheless, there was impairment of muscle tone and loss of power or lowered threshold of fatigue when compared with the right side.  Therefore, the CI’s clinical findings and symptoms when running overall favor the use of analogous code 5399-5312 with a rating of 10%.  A higher rating is not applicable for a moderately severe disability of muscles in the absence of debridement, prolonged infection or sloughing of soft parts, and intermuscular scarring or evidence of inability to keep up with work requirements.  Additionally, he had no loss of deep fascia or muscle substance, although he did have impairment due to muscle herniation and pain while running and for a short time thereafter.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left calf condition, coded 5399-5312.

BOARD FINDINGS:  In the matter of the left calf condition, the panel recommends a disability rating of 10%, coded 5399-5312 IAW VASRD §4.73, 4.55, and 4.56.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Exercise Induced Compartment Syndrome of the Left Calf	5399-5312	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180006248 XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure