RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
BRANCH OF SERVICE: ARMY
SEPARATION DATE: 20020701
NAME: XXXXXXXXXXXX
CASE NUMBER: PD1200685
BOARD DATE: 20121204
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SGT/E‐5 (63Y20/Track Vehicle Mechanic), medically
separated for chronic left calf strain. The condition began as a result of injury in 1997 and was
not associated with a surgical indication. The CI did not improve adequately with treatment to
meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical
fitness standards. He was issued a permanent L4 profile and referred for a Medical Evaluation
Board (MEB). The MEB forwarded chronic left calf strain to the Physical Evaluation Board (PEB)
as medically unacceptable IAW AR 40‐501. The MEB forwarded no other conditions for PEB
adjudication. The PEB adjudicated the left calf condition as unfitting, rated 0% with application
of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and
was medically separated with a 0% disability rating.
CI CONTENTION: The CI elaborated no specific contention in his application.
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. 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:
VA (14 Mos. Post‐Separation) – All Effective Date 20020702
Combined: 0%
*Diabetes Mellitus Type II diagnosis effective 20030520; combined 40%
ANALYSIS SUMMARY: It is noted for the record that the Board recognizes the significant
interval (14 months) between the date of separation and the first VA evaluation. DoDI 6040.44,
under which the Board operates, specifies a 12‐month interval for special consideration to VA
findings. This does not mean that the VA information was disregarded, as it was a valuable
source for clinical information and opinions relevant to the Board’s evaluation. In matters
germane to the severity and disability at the time of separation, however, the information in
Service IPEB – Dated 20020327
Condition
Code
Chronic Left Calf Strain
5099‐5021
↓No Addi(cid:415)onal MEB/PEB Entries↓
Rating
0%
Condition
Residuals, Left Lower Extremity
Stress Fracture
Diabetes Mellitus Type II*
Lumbar Strain
Aortic Arteriosclerosis,
Hypertension, Myocardial
Infarction
Code
5299‐5262
7913
5295
Rating
10%
20%
10%
Exam
20030924
20030924
20030924
7101‐7007
10%
20030924
0% X 1
Combined: 30%
20030924
the service record was assigned proportionately more probative value as a basis for the Board’s
rating recommendations.
Left Calf Condition. The left calf condition began in 1997 while running. Evaluation in 1997
with magnetic resonance imaging (MRI) showed a hematoma under the medial aspect of the
calf suggestive of a muscle tear. Initial splinting, ongoing activity restrictions, physical therapy
and medications did not alleviate the pain that continued to arise from activity. A bone scan
and electrophysiological studies of the leg in March 2000 were normal. A physical therapy
follow‐up evaluation performed on 11 September 2001 documented ankle dorsiflexion of 20
degrees (normal to 20 degrees). A clinic follow up on 25 September 2001 noted decreased
strength of the left leg. At the narrative summary (NARSUM) exam approximately 5 months
prior to separation, the CI reported left leg pain exacerbated by running, jumping, marching,
riding in tactical vehicles and prolonged standing. Examination revealed diffuse mild calf
tenderness. The ankle exhibited 0 degrees of dorsiflexion. Gait was not mentioned. At a VA
clinic follow‐up on 27 March 2003, the CI reported exercising almost every day. At the VA
Compensation and Pension (C&P) exam 14 months after separation, the CI reported continuous
pain during exercise activities and fast walking on a treadmill to less than one mile. He noted
pain severity of 2‐3 on a 0‐10 point scale with weakness and stiffness. Exercise or heavy lifting
caused the pain to flare to 4‐5/10. Such flare ups occurred once per week and lasted for 1 or 2
days. Examination revealed a normal gait. There was no calf tenderness or painful motion
noted. X‐rays showed benign appearing cortical thickening of the proximal medial tibia. The
examiner concluded that the CI suffered the sequelae of a stress fracture condition. At a
second VA exam on the same date, the CI reported no lost time from work as a full time truck
mechanic. Examination revealed a normal gait with no use of ambulatory aids. Range‐of‐
motion (ROM) of the left knee and ankle was normal (ankle dorsiflexion 20 degrees). There was
no swelling, tenderness or atrophy of the leg. Distal pulses were normal. A third concurrent
C&P examiner reported that the CI had no restriction of activities. He performed fast paced
treadmill walking of less than one mile 2‐3 times per week, and could walk at a slow pace for
40‐50 minutes. Muscle strength of the lower extremities was normal.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB’s 0% rating was assigned under the 5021 code (Myositis). This coding approach is based on
limitation of motion, but the only ROM in evidence prior to separation was ankle dorsiflexion,
which the NARSUM examiner noted to be abnormal. Board members agreed that this
limitation supported a 10% rating, and also concluded that there was ample evidence of pain
with use to justify a 10% rating under §4.40. The VA’s 10% rating under the analogous 5262
code (tibia and fibula, impairment of) was based on an assessment of “slight knee or ankle
disability.” The Board agreed that a higher rating under the 5262 code was not warranted. Due
to the symptoms of muscle pain, the Board considered rating under a muscle disability code
(5311, muscle group XI), but concluded that the condition’s severity was not more than
“moderate” under that pathway, and thus did not justify a rating greater than 10%. Finally, the
Board deliberated a peripheral nerve code (8721, neuralgia of common peroneal nerve), but
agreed this approach provided no avenue to a higher rating. After due deliberation,
considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board
recommends a disability rating of 10% for the chronic left calf strain condition.
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. The Board did not
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD
were exercised. In the matter of the chronic left calf strain condition, the Board unanimously
2 PD1200685
recommends a disability rating of 10%, coded 5099‐5021 IAW VASRD §4.71a. 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, effective as of the date of his prior medical separation:
VASRD CODE RATING
5099‐5021
COMBINED
10%
10%
Chronic Left Calf Strain
UNFITTING CONDITION
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120610, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
SFMR‐RB
XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXX, AR20120022727 (PD201200685)
1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review
(DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.
Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s
recommendation to modify the individual’s disability rating to 10% without recharacterization
of the individual’s separation. This decision is final.
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.
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.
3 PD1200685
BY ORDER OF THE SECRETARY OF THE ARMY:
Encl
XXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
4 PD1200685
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