RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04941
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Administrative Specialist, medically separated for “bilateral lower extremity compartment syndrome” with a disability rating of 0%. 

CI CONTENTION:  “I believe my condition should be changed because it has worsened.”  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 - 20050920	VARD - 20051122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Compartment Syndrome	5299-5312-8723	0%	Compartment Syndrome, Left Lower Extremity	5312-8723	0%	20050812	
			Compartment Syndrome, Right Lower Extremity	5312-8723	0%	20050812	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Lower Extremity Compartment Syndrome.  The PEB combined the left and right lower extremity conditions under a single disability rating at 0%.  This approach by the PEB reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the left and right lower extremity conditions is presented together with attendant recommendations regarding separate unfitness, and separate ratings if indicated.   

According to the STR and NARSUM, the CI’s bilateral lower extremity condition began in 2001 and continued to be aggravated with increased activities and exercise.  By July 2004, the CI could no longer run and was also experiencing bilateral foot numbness with exercise.  Definitively, her diagnosis was made on 26 October 2004 after orthopedics measured leg pressures.  

At the 12 August 2005 VA Compensation and Pension (C&P) examination, 3 months prior to separation, the CI reported bilateral lower leg pain upon running or prolonged walking.  Her physical examination (PE) revealed a normal gait.  All lower extremity joints had full range of motion and normal muscle strength with “no palpable swelling, joint effusion or tenderness.”  There were small, non-tender soft tissue masses on the outside aspect of both legs; three on the left and one on the right leg.  

At the 24 August 2005 MEB NARSUM examination, 3 months prior to separation, the CI continued to endorse bilateral leg pain with prolonged walking.  Her PE remained unchanged from the C&P examination above.  

The panel directed attention to its rating recommendation based on the above evidence.  Utilizing the same primary dual VASRD codes of 5312-8723 (muscle group XII – neuralgia of anterior tibial nerve), the PEB bundled both lower extremities into a single condition rated 0%.  The VA separately rated each lower extremity at 0%, based on the C&P examination, citing incomplete paralysis and the absence of pain, weakness, fatigue or lack of coordination and no palpable swelling, joint effusion or tenderness.  

The panel first considered if each lower extremity, having been de-coupled from the combined PEB adjudication, remained independently unfitting and ratable.  The panel acknowledged that this case revealed near normal physical findings at the time of separation.  Although it is speculative to conclude that the disability confined to either lower extremity would have rendered the CI incapable of performing within her occupational rating, the panel agreed it was reasonable to surmise that it was the overall effect of both legs that rendered her unfit.  In regards to rating the bundled lower leg condition, panel members agreed that the sole presence of small non-tender soft tissue masses found in either lower extremity without any other objective physical anomaly did not support a positive VASRD impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the bilateral lower extremity condition.  

BOARD FINDINGS:  In the matter of the bilateral lower extremity condition and IAW VASRD §4.73 and 4.124a, 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.

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Dear XXXXXXXXXX:

	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