RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05071
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050727

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Electrician’s Mate, medically separated for “closed fracture right cuboid” with a disability rating of 0%.

CI CONTENTION: “Right leg herniated calf muscle & entrapped nerve. Surgery couldn’t fix it.” 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 - 20050509	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Closed Fracture Right Cuboid	5299-5271	0%	
No VA Examination in Evidence	
Right Lower Extremity Exertional Compartment Syndrome	Cat III		
Right Superficial Peroneal Nerve Entrapment	Cat III		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Closed Fracture Right Cuboid. According to the service treatment record and MEB narrative summary (NARSUM), after falling while descending a ladder in March 2004, the CI’s right ankle condition was diagnosed and treated by physical therapy (PT) as a severe ankle sprain. At an orthopedic clinic visit in May 2004, the examiner noted the CI underwent PT for 7 weeks without much improvement and she was told multiple X-rays were negative. An 8 May 2004 right foot MRI showed a cuboid fracture, while radiographs on 24 May 2004 showed there was no longer a visible fracture line on the cuboid. The examiner’s diagnosis was a closed fracture of the right cuboid and treatment consisted of a pneumatic ankle walker. At an orthopedic clinic visit on 6 October 2004, the CI reported pain after a 5-10 minute walk and returned with increased swelling, a palpable fascial defect, and decreased sensation in the superficial peroneal nerve distribution.

On 21 October 2004 she underwent surgical release of the superficial peroneal nerve entrapment and anterior and lateral compartments. At a PT clinic visit on 17 November 2004, with full weight

bearing she ambulated in regular shoes but could not wear a military boot due to pressure. There was tenderness over the lateral shin over the incision and lateral malleolus. Dorsiflexion was 4- 12 degrees (normal 0-20) and plantar flexion was 4-55 degrees (normal 0-45). The ankle was within functional limits and there was mild swelling. An orthopedic examiner on 13 December 2004 noted the right cuboid fracture healed uneventfully. Postoperatively, the pain improved, but she was unable to use an alternating gait while ascending or descending stairs. The CI was fitted for a right knee high compression stocking in February 2005.

The 23 March 2005 MEB NARSUM examination, 4 months prior to separation, noted the complaint of right leg pain. Physical examination performed on 26 April 2004, 6 months prior to surgery, showed intact inversion on double heel raise, but the CI was unable to do a toe walk or single heel raise due to pain.. There was mild swelling diffusely at the heel, dorsal midfoot, and ankle/lateral ankle, and decreased sensation of the dorsal aspect of the forefoot. Muscle strength of the extensor digitorum longus and flexor digitorum longus muscles was 4/5, while peroneus and brevis muscles were 4+/5. Right ankle range of motion (ROM) showed dorsiflexion of 0 degrees and plantar flexion of 35 degrees. There was no VA examination in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the closed fracture of the right cuboid condition 0%, analogously coded 5299-5271 (ankle, limited motion). The panel noted the CI had a cuboid fracture, which eventually appeared to have healed, although ankle dorsiflexion postoperatively was 4-12 degrees, thereby favoring at least a moderate limitation of motion using code 5271. However, use of the code 5284 (foot injuries, other) is likewise reasonable, and a 10% rating is consistent with a moderate disability. Although the fracture had healed, the sequelae (see below) of the fracture resulted in the ankle limitation of motion and the inability to use an alternating gait while ascending or descending stairs. The use of code 5283 (tarsal, or metatarsal bones, malunion of, or nonunion) was considered since the cuboid is a tarsal bone; however, there was no malunion or nonunion proximate to separation. 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 closed fracture right cuboid condition, coded 5284.

Contended PEB Conditions: Right Lower Extremity Exertional Compartment Syndrome and Right Superficial Peroneal Nerve Entrapment. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Both conditions were noted on the 13 December 2004 limited duty forms, specifically implicated in the non-medical assessment, and according to the NARSUM examiner, the conditions interfered with reasonable performance of duties.

The MEB NARSUM examination noted the complaint of right leg pain. As noted above physical examination incorporated preoperative findings. At an orthopedic clinic visit the same day as the NARSUM examination, the CI reported she had persistent right ankle pain and swelling after prolonged standing and had pain when going up and down stairs. She was to begin functional use of the limb and advance to full weight bearing. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of right lower extremity exertional compartment syndrome and right superficial peroneal nerve entrapment favor their recommendation as additionally unfitting conditions for disability ratings, although each condition also had features as related Category III conditions. Postoperatively and by the time of separation, it appeared that the compartment syndrome symptoms had improved, although there was a limitation of motion of the ankle most likely as a result of the preoperative compression on the muscles involved in dorsiflexion. Therefore, to consider a separate rating for the muscle injuries higher than 0% for a slight disability using code 5312 (Group XII. Function: dorsiflexion), while rating for limitation of motion of the ankle would be in violation of VASRD
§4.14 (avoidance of pyramiding).

Furthermore, the panel noted that VASRD §4.55 (principles of combined ratings for muscle injuries) indicated that “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.” While the CI reported difficulty wearing a military boot, she could wear shoes. Therefore, from a functional standpoint using code 8522 (musculocutaneous nerve (superficial peroneal) for a mild incomplete paralysis offers a 0% rating, and no higher, irrespective of whether or not VASRD
§4.55 is invoked.

After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of right lower extremity exertional compartment syndrome and right superficial peroneal nerve entrapment conditions favors their recommendation as additionally unfitting conditions for a combined disability rating of 0% at the time of separation. The right lower extremity exertional compartment syndrome condition is appropriately coded 5312 and meets the VASRD §§4.56 and 4.73 criteria for a 0% rating, while the superficial peroneal nerve entrapment condition is appropriately coded 8522 and meets the VASRD §4.124a criteria for a 0% rating.

BOARD FINDINGS: In the matter of the closed fracture right cuboid condition, the panel recommends a disability rating of 10%, coded 5284 IAW VASRD §4.71a. In the matter of the right lower extremity exertional compartment syndrome condition, the panel recommends a disability rating of 0%, coded 5312 IAW VASRD §§4.56 and 4.73. In the matter of the right superficial peroneal nerve entrapment condition, the panel recommends a disability rating of 0%, coded 8522 IAW VASRD §4.124a. 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	
Closed Fracture Right Cuboid	5284	10%	
Right Lower Extremity Exertional Compartment Syndrome	5312	0%	
Right Superficial Peroneal Nerve Entrapment	8522	0%	
	COMBINED	10%	

The following documentary evidence was considered:

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

rn REPLY REFER TO,
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 23 Dec 19
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 10% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.