RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04048
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Automated Logistics Specialist, medically separated for “bilateral leg painful scars post lower leg anterior fasciotomies” with a disability rating of 10%.   

CI CONTENTION:  Review requested of the leg condition, which has continued to worsen, as well as additional 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 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 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 - 20090212	VARD - 20091020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Leg Painful Scars	7804	10%	Status Post Fasciotomy Left Leg 	5399-5312	10%	20090622	
			Status Post Fasciotomy Right Leg 	5399-5312	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bilateral Leg Scars.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent bilateral  lower leg anterior lateral fasciotomies in June 2009, but continued to have pain and was not able to return to duty in his military specialty. At an orthopedics evaluation 23 September 2008, he complained of bilateral leg pain and weakness, with no improvement in symptoms.  The provider noted well-healed scars with some surgical site tenderness, but normal sensation to light pressure distally, and full ankle range of motion.  At the 15 December 2008 MEB NARSUM examination, 5 months prior to separation, the CI reported resting pain, rated at 6/10, with radiation along the lateral lower legs into the mid-thighs; he could not walk more than 100 yards or navigate stairs without severe pain.  He had no swelling, but experienced pain with any pressure along the scars.  Physical examination showed an antalgic gait involving both legs and pain when raising both heels.  There were healed 7-cm and 9-cm surgical scars along the left and right lateral lower legs, respectively, which were very painful to palpation.  At the 22 June 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported scar and knee pain elicited by physical activity and relieved by rest.  He could function without medication and perform activities of daily living at the time of pain. Physical examination showed normal gait and posture.  There was a 7.5cm x 2.5cm scar on the left leg, and 8 cm x 2.5 cm on the right, with no pain, skin breakdown, underlying tissue damage, inflammation, swelling or disfigurement on either side.  The scars did not limit motion or function.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg scars 10%, coded 7804 (scar(s), unstable or painful), citing inability to wear boots or socks without pain, and one or two painful scars.  The VA separately rated the right and left leg conditions 10% each, analogously coded 5312 (Group IX function of the lower leg muscles), based on the STR or C&P examination, citing moderate muscle disability.  Panel members first considered whether the right and left scars remained separately unfitting, having been de-coupled from a combined PEB adjudication.  In this case, the bilateral leg scars were profiled and considered to fail retention standards.  The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either leg scar over the other.  Since undue speculation would be required to conclude that impairment from either leg scar would not have unacceptably interfered with the performance of military duties, the panel agreed that each leg scar was reasonably justified as separately unfitting and met criteria for 10% ratings under code 7804.   A higher rating of 20% for either leg scar was not indicated in the absence of “three or four unstable or painful scars. “  The panel considered other scar and muscle codes, but all were less applicable or advantageous for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% each for the right and left leg scars, coded 7804.  

BOARD FINDINGS:  In the matter of the painful bilateral leg scars, the panel recommends a separate disability rating of 10% each for the right and left leg scars, coded 7804 IAW VASRD §4.118.  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	
Left Leg Painful Scar	7804	10%	
Right Leg Painful Scar	7804	10%	
COMBINED	20%	

AR20200000642, XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX:

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.