RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04168
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20061010

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Submarine Machinist Mate, medically separated for “bilateral lower extremity exercise induced compartment syndrome [CS],” rated 10% each leg, with a combined disability rating of 20%.

CI CONTENTION: In addition to the bilateral lower extremity CS, review requested of bilateral leg scars which were 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 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 - 20060621	VARD - 20070406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Exercise Induced CS	5399-5312	10%	Right Lower Exercise Induced CS	5399-5312	0%	20061024	
	5399-5312	10%	Left Lower Exercise Induced CS	5399-5312	0%	20061024	
Bilateral Tibial Stress
Reactions	Cat II	Bilateral Tibia Stress	5015	NSC	20061024	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Bilateral Lower Extremity Exercise Induced CS. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgery with compartment releases to the right leg in November 2004 and to the left leg in February 2005. Although surgery provided significant relief, he continued to have numbness, tingling and cramps in his lower extremities with exercise. A bone scan in January 2006 showed mild bilateral stress fractures of the distal tibial cortices, but bilateral lower extremity imaging in April 2006 was unremarkable. Additional surgery was reasonably declined.

The 22 May 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of significant bilateral lower leg exercise-induced CS symptoms. Physical examination showed a normal steady gait without antalgia, well-healed lower extremity fasciotomy scars, and large calf

muscles bilaterally. All compartments were soft but non-tender, and there was some decreased cutaneous sensation proximate to the right leg scar. Muscle strength, reflexes and vascular testing were normal.

At the 24 October 2006 VA Compensation and Pension (C&P) examination, 2 weeks after separation, the CI reported bilateral lower leg pain with paresthesias, weakness and pain radiating up and down the legs. Pain was elicited by activity and stress. Physical examination revealed a normal posture and gait. Bilateral ankle and knee range of motion was full and painless. Scars on both lower legs were non-tender. Examination of both the right and left tibia and fibula revealed normal findings. There were no lower extremity motor, sensory, reflex or vascular deficits. Bilateral X-rays of the tibias and fibulas were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right and left CS 10% each leg, analogously coded 5399-5312 (muscle group XII injury). The VA rated the right and left CS 0% each leg, analogously coded 5399-5312, based on the C&P examination, citing slight muscle disability with “minimal scarring, and no evidence of fascial defect, atrophy, impaired tone, impaired function or retained metallic fragments.” The PEB listed bilateral tibial stress reactions as a Category II condition (related to and contributed to the primary unfitting condition). The panel’s first charge was to assess whether it could be reasonably justified as separately unfitting for rating consideration. The panel noted the stress fractures were no longer present at the time of the NARSUM and any residual pain from them was intrinsic to the rated condition. A separate rating therefore cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating. The panel considered VASRD §4.56 (evaluation of muscle disabilities) and adjudged that there was insufficient evidence of any disability more nearly approaching the next higher moderately severe criteria for either leg under any applicable §4.73 (muscle injuries) code. Alternative rating under §4.71a (musculoskeletal system) provided no higher rating for either leg. 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 bilateral (left and right) lower extremity CS.

BOARD FINDINGS: In the matter of the right and left lower extremity CS 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:

2	PD-2017-04168

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

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.