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AF | PDBR | CY2012 | PD2012 01403
Original file (PD2012 01403.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201403
BRANCH OF SERVICE: Army  BOARD DATE: 20130403
SEPARATION DATE: 20060602


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty SGT/E-5 (92Y, Supply) medically separated for bilateral leg pain. CI claimed the pain began with a stress fracture in 2000 and worsened after a 2005 fitness test. Mild exercise-induced compartment syndrome (EICS) was diagnosed. Physical therapy (PT) and activity modification could not adequately rehabilitate the leg pain to 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 characterized his condition as “exercise-induced compartment syndrome” EICS and forwarded it to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated bilateral lower leg pain secondary to EICS as unfitting, rated 0%, citing the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with that rating.


CI CONTENTION: The CI elaborated no specific contention in his application.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral leg pain condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 IPEB – Dated 20060516
 VA - (6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilat Leg Pain
 5399-5312 0% Bilat Lower Stress Fx w/Compartmental Syndrome 5262 0%* 20061201
Bilateral Shin Splints 5262 0%* 20061201
No Additional MEB/PEB Entries
 Other x 10 20061201
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70326 ( most proximate to date of separation (DOS) ).
* VARD , dated 20121105, increased rating for shins from 0% to 10% effective with DOS.


ANALYSIS SUMMARY: The PEB combined the bilateral leg pain conditions as a single unfitting condition, coded analogously to 5399-5312 and rated 0% . The PEB may have relied on AR 635.40 (B.24f) and the USAPDA pain policy for not applying separately compensable VA Schedule for Rating Disabilities (VASRD) codes. The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW VASRD §4.71a. If the Board judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each ‘unbundled’ condition was unfitting in and of itself. Thus the Board must exercise the prerogative of separate fitness recommendations in this circumstance, with the caveat that its recommendations may not produce a lower rating than that of the PEB.

Bilateral Leg Pain Secondary to Exercise Induced Compartment Syndrome (EICS). The narrative summary (NARSUM) notes the CI had a lower leg pain that began in 2000 with bilateral tibial stress fractures and was worsened by physical activity. The CI improved with rest and physical therapy (PT), but the pain returned with increased activity. He was placed on a profile of no running and was unable to progress. Despite recurring bilateral leg pain, a bone scan performed 12 September 2005 was normal and a diagnosis of mild EICS was made on a clinical basis without supporting diagnostic testing evidence. At the MEB NARSUM exam 5 April 2006, approximately 2 months pre-separation, the CI reported marked and constant pain of his lower legs. The MEB physical exam noted normal posture, gait, muscle strength, full range-of-motion (ROM) of all joints, with no pain, weakness or fatigue. An orthopedic assessment, 15 December 2005, was “Patient has mixed EICS and tibial stress rx, and will not benefit from surgical intervention. His continued pain is a result of his stress fx….” At the VA Compensation and Pension (C&P) exam, 1 December 2006, approximately 6 months after separation, the CI reported bilateral pain, weakness, and swelling in the calves. He denied any locking, giving way, or instability. Flare-ups occurred due to running or walking with symptoms for approximately an hour after stopping exercise. He reported limiting his walking to 45 minutes and jogging to 100 yards. The exam showed tenderness of the calf and tibial area; gait was “steady.” Muscle strength was 5 out of 5 with no decrease with repetitive motion. There was no swelling, redness, heat, or painful motion. No neurological deficits were noted.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated a single unfitting condition of bilateral leg pain as 5399-5312 (analogous to injury of Muscle Group XII) at 0%. The VA rated bilateral stress fracture with compartmental syndrome as 5262 at 0%. A prior VA Rating Decision in December 2003 rated bilateral shin splints as 5262 at 0%. The Board now undertook to unbundle the bilateral legs. The permanent profile notes “leg pain (exercise induced compartment syndrome);” all preceding temporary profiles listed bilateral leg conditions. The commander’s statement refers only to the CI’s “disability.” Service treatment record (STR) notes, including the NARSUM, indicate bilateral EICS with a history of bilateral tibial stress fractures. The Board agreed that based on the evidence in the record each leg was in itself unfitting. The Board noted that the CI’s disability due to pain of the lower legs was diagnosed as EICS clinically, after repeat bone scans were negative. No specific testing to diagnose EICS was undertaken; the evidence in the record did not mention swelling or tenseness of the lower leg muscles; and the pain with activity was not associated with other deficits of muscle weakness, atrophy, decreased ROM, or sensory loss. The Board opined that the CI’s disability due to pain in both legs was mild and did not rise to the 10% rating coding either IAW §4.73 or §4.71a. Having unbundled the bilateral leg condition, the Board found that it resulted in no benefit to the CI. Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral leg pain 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. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral leg pain condition. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Bilateral Leg Pain
5399-5312 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120607, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130009512 (PD201201403)

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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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