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AF | PDBR | CY2013 | PD-2013-01312
Original file (PD-2013-01312.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01312
BRANCH OF SERVICE: Army  BOARD DATE: 20150421
SEPARATION DATE: 20040727


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Infantryman) medically separated for exertional compartment syndrome (ECS). The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “right intercompartment chronic exertional compartment syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated exertional compartment syndrome as unfitting, rated 0%, c iting application of the U.S. Army Physical Disability Agency Policy/Guidance Memorandum #12, dated 8 April 2002, Subject: Table of Analogous Codes. The CI made no appeals and was medically separated.


CI CONTENTION: “I feel that I was not informed correctly on the severity or the permanentness of my condition. I have a lot of time to research my condition and talk to several doctors to find out that due to the late diagnosis and around 2 years of being told to muscle through the pain. That has caused my injury to not only become permanent and that the symptoms occur sooner and last longer. Over the years my condition has worsened and caused chronic pain and limited mobility. If I knew this information at the time of my discharge that I would have fought my decision for a realistic settlement for my injury.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.



 RATING COMPARISON :

IPEB – Dated 20040423
 VA* - (~3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Exertional Compartment Syndrome 5399-5312-8723 0% Exertional Compartment Syndrome 5299-5312 10% 20040420
Other x 0 (Not In Scope)
 Other x 2
RATING: 0%
 RATING: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 40908 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Exertional Compartment Syndrome. The narrative summary noted the CI developed persistent right leg pain during basic training. Notes in the service treatment record indicated that the CI reported right leg pain after running and was evaluated for anterior leg pain. Lower leg X-rays and bone scan were normal without evidence of stress fractures. Evaluation by a vascular surgeon for claudication (arterial insufficiency) was normal. The CI was evaluated in the emergency room for right leg pain and swelling on 21 May 2003. The CI was evaluated by a podiatrist and referred to sports medicine (SM). Initial diagnoses included tendinitis of the knee and ankle and the CI was placed in a controlled ankle motion boot (CAM walker) with improvement in the leg pain. The CI returned from 2 weeks of leave and reported he had no pain, despite only using the CAM walker outside of the house. He was weaning off the CAM walker but reported he “overdid” it and at a SM visit on 4 December the CI reported return of the pain and noted “2 knots that stick out.” The exam noted minimal tenderness of the leg with palpable fascial hernia in the squatting position, and pain with single leg hop. The SM specialist suspected ECS. Right leg compartment pressures measured before and after exercise on 11 December 2003 were consistent with ECS and pain was noted to decrease after 10 minutes of rest. The CI was referred to an orthopedic surgeon for consideration of the treatment options. The orthopedic evaluation on 5 January 2003 noted right leg ECS with muscle herniation. Treatment options were reviewed which included a profile and activity modification or surgery, but the surgeon noted that full return to duty was unlikely with any choice of treatment. The CI declined surgical intervention which the surgeon was thought was reasonable in his case and a MEB was recommended. At the MEB examination on 2 February 2004, 6 months prior to separation, the CI reported pain and swelling in his leg and foot numbness after several minutes of running or walking less than a mile, with no symptoms of the left leg. The MEB physical exam noted full range-of-motion of the knee and ankle. There was no tenderness to palpation of the lower leg at rest. Nerve and motor function were intact and pulses were normal. Two areas of muscle herniation were noted with squatting. The compartment pressures measured by Sports Medicine were cited. The MEB examiner noted that podiatry consultation found no contributory foot or ankle disorders.

At the VA Compensation and Pension examination on 20 April 2004, 3 months prior to separation, the CI reported the same symptoms noted at the MEB. The exam noted normal posture and gait. The muscle herniation was noted with no other muscle abnormalities. There was no swelling, ulceration, or dermatitis of the lower extremities. The examiner noted involvement of muscle Group XII and noted strength was normal but that muscle injury limited ambulation, running, and squatting due to pain and swelling.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right ECS 0%, coded 5399-5312-8723 (analogous to neuralgia of the deep peroneal nerve with muscle Group XII injury) and the VA rated it 10%, coded 5299-5312 (analogous to muscle Group XII injury), an analogous code for anterior compartment syndrome.
The Board first considered the coding of the ECS condition. The Board noted that the rating criteria of 8723 are subjective with 0% for mild and 10% for moderate deep peroneal neuralgia. The evidence supports that the CI experienced symptoms during exercise referable to the deep peroneal nerve of anterior lower leg pain and foot numbness, but otherwise had a normal gait with no permanent sensory or motor deficits of the leg and no symptoms at rest. Members agreed that the disability due to the ECS condition met the 0% rating coded according to 8723 criteria for mild incomplete paralysis, but not the 10% rating for moderate incomplete paralysis. The Board reviewed to see if alternatively rating IAW §4.73 (Muscle injuries) as did the VA provided a higher evaluation. Members noted that rating criteria of 5312 are subjective and similar to the 8723 criteria with a 0% rating for slight, 10% for moderate, and 20% for moderately severe muscle injury. The Board agreed that the ECS condition exceeded the criteria for slight muscle injury due to the presence of cardinal symptoms of muscle injury of reproducible muscle pain and swelling that limited activity (fatigue-pain). Member consensus was that the ECS condition was best described as moderate and not moderately severe based upon the complete absence of leg symptoms at rest or with mild activity. The Board finally reviewed coding as 5326 (muscle hernia, extensive) but found that the highest rating available was 10% for extensive muscle herniation, so utilizing this code would not result in a rating higher than 10%. Therefore, the Board agreed that the evidence supports a 10% rating coded 5399-5312, but did not support a higher rating with any applicable code. 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 right ECS 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. In the matter of the right ECS condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5312 IAW VASRD §4.73. 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:

CONDITION VASRD CODE RATING
Exertional Compartment Syndrome 5399-5312 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130911, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review


SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXX , AR20150011046 (PD201301312)


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.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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