RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05454
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Engineer Equipment Mechanic, medically separated for “right leg exertional compartment syndrome” with a disability rating of 10%.

CI CONTENTION: In addition to receiving a higher rating by the VA for the right leg condition, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 - 20060217	VARD - 20061206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Leg Exertional
Compartment Syndrome	5399-
5312	10%	S/P Shrapnel Wound, Fasciotomy Release Anterior and Lateral Compartments due to Exertional Compartment Syndrome, Peroneal Nerve Damage, and Residual
Scars Right Lower Extremity	
5399-
5312	
30%	
20060315	
Right Leg Peripheral Nerve Injury	Cat II					
Right Leg Shrapnel Wound	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Right Leg Exertional Compartment Syndrome. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right leg condition began in July 2004 when he was struck by shrapnel from a roadside IED, had lacerations of the right leg, and neuropraxia of the cutaneous branch of the right superficial peroneal nerve. Conservative wound care was carried out. Thereafter, he developed symptoms of exertional compartment syndrome marked by elevations in the anterior and lateral compartments. In November 2005 he underwent fasciotomies of those compartments and a piece of shrapnel was removed from the lateral compartment. Another piece of shrapnel proximally and deep in the musculature was not removed. Postoperatively, he continued to have pain in the right leg, which was not controlled with a narcotic medication, along with dysesthesia distal to the incision in the distribution of the superficial peroneal nerve.

The 17 January 2006 MEB NARSUM examination, 3 months prior to separation, noted the complaint of right leg pain. Physical examination showed a surgical incision in the lateral aspect of the leg approximately 15 cm long. The patient also had two entry shrapnel wounds which were healed, one in the mid-portion of the calf laterally and another more proximally and posteriorly. There was no evidence of infection. He had a Tinel’s sign (nerve irritation) over the distal incision. The motor examination demonstrated normal motor strength distally in the extensor hallucis longus, gastrocnemius soleus complex, and toe extensors. The leg was otherwise neurovascularly intact and calf muscle bulk was symmetric bilaterally. Knee and ankle range of motion (ROM) was normal.

At the 15 March 2006 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported pain in the right thigh and numbness of the right leg and foot. Physical examination showed multiple scars on the right lower leg, all of which were level without tenderness, disfigurement, ulceration, adherence, instability, edema, inflammation, tissue loss, keloid formation, hypopigmentation, hyperpigmentation, or abnormal texture. Gait was normal. There were no atrophic skin changes, nor was there ulceration, gangrene, ischemic limb pain or persistent coldness. There was no edema of the right and left lower extremities. The muscle strength on the right lower extremity muscles was 4/5. There was no muscle herniation or tendon damage, but there was nerve damage on the right peroneal nerve with decreased sensation, and numbness starting from the right foot up to the right knee. Right hip, knee and ankle ROM measurements were normal with painful motion of the right ankle.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right leg condition 10%, analogously coded 5399-5312 (Group XII. Function: dorsiflexion). The panel agreed that the two additional Category II diagnoses of right leg peripheral nerve injury and right leg shrapnel wounds were conditions which contributed to or were related to the primary unfitting condition but are intertwined with the primary diagnosis and were subsumed under a muscle code Group XII; thus, more than one rating based on the same impairment is prohibited IAW §4.14 (avoidance of pyramiding). The VA rated the right leg condition 30%, analogously coded 5399-5312 based on the C&P examination, citing residuals of the fasciotomy release, peroneal nerve damage, and reduced function of the right ankle.

The 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.” However, “for compensable muscle group injuries which are in the same anatomical region but do not act on the same joint, the evaluation for the most severely injured muscle group will be increased by one level and used as the combined evaluation for the affected muscle groups,” while “for muscle group injuries in different anatomical regions which do not act upon ankylosed joints, each muscle group injury shall be separately rated and the ratings combined under the provisions of §4.25.”

The STR indicated the CI underwent fasciotomies of both the anterior and lateral compartments of the right leg including removal of a piece of shrapnel from the lateral compartment and one piece was too deep to remove. VASRD §4.56 (evaluation of muscle disabilities) provides guidance for rating and indicates “a through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged” and 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.” A moderate disability of the muscles requires “through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection” with objective findings including “entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side.” A moderately severe disability

of muscles requires “through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring” with objective findings of “entrance and (if present) exit scars indicating track of missile through one or more muscle groups…[with] indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment.”

The PEB rated the CI’s condition 10% for a moderate disability, while the VA rated condition 30% for a severe disability. The panel members agreed that at minimum the CI warranted a 20% rating for the right leg exertional compartment syndrome based on involvement of both anterior and lateral compartment fasciotomies as well as retained shrapnel and decreased muscle strength. The panel then discussed whether the condition rose to a severe disability of muscles as a result of a “through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring” with objective findings of “ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track.”

The CI underwent fasciotomies of two compartments, and there were multiple scars, but there was no loss of deep fascia or muscle substance. There was no indication of swollen or hardened muscles and strength was 4/5 for muscles in both the anterior and posterior compartments of the right leg., This did not seem to rise to indicate a severe impairment of function especially since the CI’s gait was normal and no significant muscle atrophy was reported, although there was still shrapnel present in the deep lateral musculature. Therefore, although the condition was significant, it did not rise to the level of a severe disability at the time of separation. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right leg exertional compartment syndrome, coded 5399-5312.

BOARD FINDINGS: In the matter of the right leg exertional compartment syndrome, the panel recommends a disability rating of 20%, coded 5399-5312 IAW VASRD §§4.56 and 4.73.
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	
Right Leg Exertional Compartment Syndrome	5399-5312	20%	

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 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 2 Jan 20
(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 (PEE) from 10% to 20% 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 office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.