RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05910 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20051115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Vehicle Operator, medically separated for “left peroneal neuropathy” with a disability rating of 20%.

CI CONTENTION:	“Disability  rating  assessment  was  isolated  to one injury.”	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 - 20070907	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Peroneal Neuropathy	8621	20%	
No VA Examination in Evidence	
Left Snapping Hip	Cat II		
Left Iliotibial Band Syndrome	Cat II		
Left Greater Trochanteric Bursitis	Cat II		
Left Piriformis Syndrome	Cat II		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	
	
ANALYSIS SUMMARY:

Left Peroneal Neuropathy. According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of left hip pain since 2001 after falling on his left side during a march and injuring his left hip, knee and ankle. He was subsequently treated with physical therapy for snapping hip syndrome. At a sports medicine visit on 4 February 2003, the CI reported that a few minutes into a run, he developed low back pain with anterior lateral thigh

numbness extending into the left calf, as well as foot drop and a clicking in his hip. Physical examination showed a normal gait and lumbar area tenderness without signs of dysfunction of the peroneal nerve (foot drop) or tibialis anterior muscle (for foot dorsiflexion). A lumbar spine MRI on 24 February 2003 was normal.

At a primary care visit on 11 April 2003, the CI reported re-injuring his left hip on a course that morning. Physical examination showed normal strength and sensation, but hip pain with abduction and internal and external rotation. He was treated for trochanteric bursitis and piriformis syndrome (sciatic nerve irritation from piriformis muscle which originates from the anterior sacrum and inserts on the greater trochanter of the femur and crosses the sciatic nerve) without relief. A limited duty board dated 24 March 2005, 8 months prior to separation, listed diagnoses of left L5 radiculopathy “versus peroneal neuropathy,” iliotibial band syndrome (ITBS), piriformis syndrome and trochanteric bursitis, and prohibited running or sit-ups, physical readiness testing, prolonged sitting and deployment. Further evaluation of the CI’s symptoms was planned.

At a sports medicine appointment on 5 May 2005, 6 months before separation, physical examination prior to exercise showed 5-/5 strength of the left lower extremity, decreased sensation to light touch in the peroneal distribution, and normal toe and heel walk without weakness. After exercise, strength of dorsiflexion of the foot and great toe was decreased to 4/5 and heel walking was difficult, while toe walking was normal. Electrodiagnostic studies performed on 29 July 2005 showed left peroneal neuropathy without evidence of radiculopathy, and the diagnosis was left peroneal nerve entrapment at the level of the piriformis muscle.

The 2 August 2005 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of left lateral and posterior leg pain with numbness and tingling, aggravated by sitting or running. Physical examination showed decreased sensation in the peroneal nerve distribution, and tenderness of the trochanteric bursa, piriformis muscle, and the ITB at the knee. There was also exacerbation of numbness and tingling and sciatic symptoms with piriformis stretching. Lumbar spine range of motion (ROM) was described as “full” with 65 degrees of flexion noted (normal 60), 25 degrees of extension (normal 30), and 20 degrees of lateral flexion bilaterally (normal 30). Hip ROM was described as mildly restricted with extension of 30 degrees (normal). The examiner noted that a repeat lumbar spine MRI in 2005 was negative. Prior to a one-mile exercise challenge, lower extremity muscle strength was graded 5/5, but after the test, the CI had decreased dorsiflexion and peroneal eversion strength, graded 4/5, as well as difficulty with heel walking. The examiner stated that duty limitations included no participation in physical readiness tests or running, and no deployment aboard a ship or remote from a military treatment facility. The commander’s non-medical assessment dated 10 August 2005, indicated the peroneal neuropathy impaired the successful performance of duties. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left peroneal neuropathy 20%, coded 8621 (common peroneal neuritis), and listed left snapping hip, ITBS, greater trochanteric bursitis and piriformis syndrome as related diagnoses (Category II) contributing to the disability in this case. Panel members noted that the piriformis syndrome was the cause of the peroneal neuropathy, and thus could not be separately considered for fitness or rating. The snapping hip and trochanteric bursitis caused hip pain, and the ITBS mainly caused hip pain, but to a lesser degree, knee pain. Hip and knee pain from these conditions overlap the distribution of the left lower extremity pain due to the neuropathy and whether separately unfitting or not, cannot be rated separately IAW VASRD §4.14 (avoidance of pyramiding). The panel agreed there was evidence to support a 20% rating, but no higher, for moderate neuritis of the common peroneal nerve causing left lower extremity pain, decreased sensation and intermittent mild weakness, predominately with running. 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 left peroneal neuropathy.

BOARD FINDINGS: In the matter of the left peroneal neuropathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended left snapping hip, iliotibial band syndrome, greater trochanteric bursitis and piriformis syndrome, the panel agrees it cannot recommended additional disability ratings. 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.

20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY  BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr <ltd 28 Jun 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 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.