RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200809 SEPARATION DATE: 20020102 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered 
individual (CI) was an active duty Soldier, SGT/E-5(68B/Aircraft Powerplant Repairer), medically 
separated for chronic bilateral leg pain. The CI began suffering exertional pain in 1999 while stationed in 
Korea, and was diagnosed with bilateral compartment syndrome of his lower extremities. The CI did not 
improve adequately with surgical and medical treatment and was transferred to Ft. Gordon’s medical 
holding company. He could not meet the physical requirements of his Military Occupational Specialty 
(MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded bilateral leg pain as medically unacceptable IAW 
AR 40-501. The MEB forwarded no other conditions for Informal Physical Evaluation Board (IPEB) 
adjudication. The IPEB adjudicated chronic bilateral leg pain status post (s/p) fasciotomies as unfitting, 
rated 0%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) and the US 
Army Physical Disability Agency (USAPDA) pain policy. The CI appealed to the Formal PEB (FPEB), which 
increased the IPEB rating to 10%. The CI was then medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “The original PEB rated combined condition with a disability rating of 10%. However 
the VA rated the condition within 12 months of discharge with a rating of 30%. The disability rate 
increased again within 24 months from ETS date to 50%. Current combined disability rating is 70% 
(awarded in 2008). All of the rated medical conditions existed at the time of the service member's 
discharge and PEB unfairly forced service member out of the service without the proper disability rating, 
which would have qualified for medical retirement.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 
Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be 
specifically unfitting for continued military service; or, when requested by the CI, those condition(s) 
“identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be 
reviewed in all cases. The unfitting condition of chronic bilateral leg pain will be addressed below. Any 
conditions or contention not requested in this application, or otherwise outside the Board’s defined 
scope of review, remain eligible for future consideration by the Army Board for Correction of Military 
Records. 

 


RATING COMPARISON: 

 

Service FPEB – Dated 20011024 

VA (8 Mos. Post-Separation) – All Effective Date 
20020103 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Bilateral Leg 
Pain 

5099-
5003 

10% 

Left Ankle; S/P 
Fasciotomy … w/Residuals 
of Peroneal Neuropathy … 

8521 

20% 

20020827 

Right Ankle; S/P 
Fasciotomy … w/Residuals 
of Peroneal Neuropathy … 

8521 

10%* 

20020827 

.No Additional MEB/PEB Entries. 

0% X 0 / Not Service-Connected x 0 

20020827 

Combined: 10% 

Combined: 30%* 



VARD 20030905 increased R 8521 to 20% effective 20030602 (combined 50% with added knee 
conditions). Scars added effective 2007 (combined 70%). 

 

 

ANALYSIS SUMMARY: The PEB combined bilateral leg pain as a single unfitting condition, coded 
analogously to 5003 and rated at 10% according to the USAPDA Pain Policy. Although VASRD §4.71a 
permits combined ratings of two or more joints under 5003, it allows separate ratings for separately 
compensable joints; and, IAW DoDI 6040.44, the Board must follow suit if the PEB combined 
adjudication is not compliant with the latter stipulation. The Board’s initial charge in this case was 
therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate 
ratings. If the members judge that separate ratings are indicated IAW VASRD §4.7 (higher of two 
evaluations), however; each unbundled condition must be reasonably justified as separately unfitting to 
remain eligible for rating. When the Board recommends separate ratings in this circumstance, the result 
may not be lower than the overall combined rating from the PEB. 

 

Chronic Bilateral Leg Pain Condition. All records and exams refer to bilateral lower leg pain. The 
narrative summary (NARSUM) notes the CI had persistent bilateral leg pain following fasciotomies for 
compartment syndrome of both his lower legs. He was referred to the MEB when he was not able to 
exercise to a level sufficient to come off his profiles. The goniometric range-of-motion (ROM) 
evaluations in evidence which the Board weighed in arriving at its rating recommendation, with 
documentation of additional ratable criteria, are summarized in the chart below. 

 

Ankle ROM 

(in degrees) 

PT ~4 Mo. Pre-Sep 

MEB 
Addendum ~3 
Mo. Pre-Sep 

VA C&P ~8 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Dorsiflexion (0-
20) 

5 

10 

Referenced PT 
exam; see text 

10 

20 

Plantar Flexion (0-
45) 

20 

15 

15 

45 

Comment 

Decreased str 4/5 DF/PF 
ankle, 3/5 remainder of ankle 
and great toe 

Abn gait, nerve damage, 
dec. str; foot drag, pain 
weakness, incoordination 
(L) 

§4.71a Rating 

10% 

10% 

20% 

10% 



 

At the MEB exam, about 7 months prior separation, the CI noted that as long as he does not exert 
himself, he does well, but with activity he will develop lower leg pain that worsens with increasing 
exercise. The MEB physical exam noted bilateral tibial tenderness to palpation, but good strength, full 
ROM, and normal reflexes. The NARSUM addendum stated that the CI had additional studies: Nerve 
condition studies/Electromyography (NCS/EMG) and physical therapy (PT) strength/ROM testing. 
NCS/EMG was done to assess the CI’s complaint of left lower extremity (LLE) pain that radiates from the 
scar of his left lower leg to the lateral aspect of his foot. Bilateral NCS were done; EMG was done of the 
LLE only. The study was consistent with LLE deep peroneal neuropathy. There was no muscle wasting 


or atrophy of the LLE, but PT noted strength 3/5 limited by pain. ROM noted in the table above shows 
bilateral decreased dorsiflexion and plantar flexion. The MEB examiner characterized the ROM at the 
MEB exam as normal, and referred to the PT ROM as also “within normal limits.” The examiner further 
stated that “there is evidence ……. of left deep peroneal neuropathy and some slight decrease in muscle 
strength of the right and left ankle. It is hard to say at this point whether both of these findings would 
fail retention standards.” At the VA Compensation and Pension (C&P) exam about 8 months after 
separation, the CI reported pain of the right and left shin, feet and toes. He complained of loss of 
strength, weakness and fatigue of the left leg, as well as pain in both legs. He reported being unable to 
run without extreme pain, of having trouble walking, riding a bicycle, and “limited normal work 
requirements.” The VA exam showed an abnormal gait with moderate foot drag, left greater than right; 
evidence of nerve damage; muscle groups XI (plantar flexion) and XII (dorsiflexion) involved; decreased 
strength 3-4/5 especially dorsi and plantar flexion of the left foot; +Tinel’s sign with hyperesthesia of 
the left lateral leg and “much less so on the right;” and normal DTRs. ROM of the ankles is noted in the 
table, with decrease on the left. There was pain, weakness and incoordination noted with movement on 
the left. No diagnostic studies were done at that exam. The diagnoses were s/p bilateral fasciotomy for 
compartment syndrome, and peroneal neuropathy of the right and left ankles, left greater than right. 

 

The Board directs attention to its rating recommendation based on the above evidence. The evidence 
from the NARSUM and service treatment record (STR) supports the bilateral leg pain condition as 
unfitting. As elaborated below, separate compensable ratings for each lower leg were well supported 
by the evidence in this case. As to the judgment as to whether each lower leg condition was 
independently unfitting, neither the profile nor the commander’s statement specifically implicated the 
right or left leg pain as the primary unfitting condition. The CIs symptoms involved both LEs from the 
beginning; the treatment consisted of fasciotomies for compartment syndrome in both LEs; and clinic 
records about the time of referral to the MEB noted persistent problems with bilateral LE pain. The 
Board opined that although the findings and symptoms of the LLE post-surgery were noted as worse 
than the right in the record, separating the impairment related to the left lower leg from that related to 
the right requires undue speculation; and, there is clinical evidence of significant functional impairment 
referable to each lower extremity. After due deliberation, the Board unanimously agreed that there was 
reasonable evidence that each of the lower leg pain conditions, would have rendered the CI incapable of 
continued service within his MOS; and, accordingly each merits a separate disability rating. 

 

Left Leg Condition. As noted above, the PEB rated “chronic bilateral leg pain” as “slight/frequent” as 
5099-5003 at 10% and cited the USAPDA Pain Policy. The VA rated s/p fasciotomy with residuals of 
peroneal neuropathy left ankle as 8521 (incomplete paralysis of the common peroneal nerve) at 20% 
(and rated the right ankle also as 8521 at 10% with application of the bilateral factor combined to 30%). 
The NCS/EMG of the LLE was abnormal with evidence of deep peroneal neuropathy. The NARSUM 
noted decreased strength with pain. The VA exam and PT ROMs in the STRs showed decreased ROM. 
The Board agreed that the evidence in the record supports moderate disability of the LLE. Coding with 
5271 for moderate limitation of ankle motion would result in a 10% rating for the left ankle. The Board 
opined that with the additional EMG/NCS information, the level of fasciotomy scars, and the additional 
pain/neuralgia consideration that coding with 8521 External popliteal nerve (common peroneal) was the 
appropriate nerve level. Neuralgia coding under 8721 was considered, but was not predominate. The 
Board deliberated over the “mild” 10% level and the “moderate” (20%) rating level with consideration of 
VASRD §4.120, §4.123 and §4.124. The Board majority considered the CI’s disability picture more 
closely approximated that of the moderate incomplete paralysis of the common peroneal nerve which 
provided the fair and equitable rating of the left leg pain. After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt), §4.7 (higher of two evaluations) and §4.40 
(functional loss), the Board majority recommends a disability rating of 20% for the chronic left leg 
condition coded as 8521 IAW VASRD §4.124a. 

 

Right Leg Condition. The VA rated s/p fasciotomy with residuals of peroneal neuropathy right ankle as 
8521 at 10%. Although the NCS/EMG of the right LE did not show evidence of a neuropathy as on the 
left, there was pain with use and decreased right ankle strength and great toe strength commensurate 


with that of the left. The majority of the records indicated that post-operatively the RLE condition was 
not as severe as the LLE. The Board agreed that the evidence in the record supported a mild disability of 
the right lower extremity. The Board acknowledged the lack of NCS/EMG evidence of a neuropathy on 
the right and considered rating as 5271 (limitation of ankle motion) with application of VASRD §4.59 at 
10%. The Board deliberated coding with the PEB choice of 5099-5003 as it likewise results in a 10% 
rating. However, with the above findings of weakness, decreased ROM and pain, and absent any 
intrinsic ankle pathology, the Board opined that coding with 8599-8521 (analogous to incomplete 
paralysis of the common peroneal nerve) was more consistent with the medical basis of the CI’s right leg 
pain. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), VASRD §4.4 (functional loss), the Board unanimously recommends a disability rating of 10% for 
the right leg condition coded as 8599-8521 IAW VASRD §4.124a. 

 

 

BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance 
on the USAPDA pain policy for rating the chronic bilateral leg pain condition was operant in this case and 
the conditions were adjudicated independently of that policy by the Board. In regards to the bilateral 
leg conditions combined under a single 5003 rating by the PEB, the Board unanimously recommends 
that each leg be individually unfitting and individually rated. The Board unanimously recommends 
rating the chronic right leg condition coded 8599-8521 at 10% IAW VASRD §4.124a. The Board, by a 2:1 
vote recommends rating the chronic left leg pain condition, coded 8521 at 20% IAW VASRD §4.124a. 
The single voter for dissent (who voted for the chronic left leg pain condition rating at 10%) elected not 
to submit a minority opinion. There were no other conditions within the Board’s scope of review for 
consideration. 

 

 

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows; 
and, that the discharge with severance pay be recharacterized to reflect permanent disability 
retirement, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Left Leg Pain 

8521 

20% 

Chronic Right Leg Pain 

8599-8521 

10% 

COMBINED (w/ BLF) 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120617, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxx, AR20130005084 (PD201200809) 

 

 

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay. 

 

2. I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum: 

 

 a. Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was retired with permanent 
disability effective the date of the original medical separation for disability with 
severance pay. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 

 

 d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 
and medical TRICARE retiree options. 

 

 

 

 

 

 

3. I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 


shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 

 

BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)