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AF | PDBR | CY2013 | PD-2013-02295
Original file (PD-2013-02295.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02295
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20141001
SEPARATION DATE: 20050615


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active LCpl/E-3 (1171/Water Support Technician) medically separated for a left lower extremity (LLE) condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The LLE condition, characterized as “pain in soft tissues of limb” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “left lower extremity pain, unknown etiology” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Should be rated higher.”


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 left lower extremity condition is addressed below; 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 Board for Correction of Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20050328
 VA - (One Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
LLE Pain 5399-5312-8723 10% S/P Fasciotomy …of the LLE 5312 10% 20050505
Other x 0 (Not in Scope)
 Other x 4 20050505
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 51118 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Left Lower Extremity Condition. The service treatment record indicated the CI developed increasing pain from a “knot on the left leg” for about a week prior to being medically evaluated in December 2003. The painful “knot,” described as a nodule or bulge, was localized to the left lateral mid-calf and presented when running and resolved without activity. No fascial (a sheet or band of fibrous connective tissue surrounding muscle) defect was detected initially, although a possible tear versus muscle strain/tear was raised as diagnostic possibilities. Shin splints (bone pain due to micro injuries) of the left leg and an internal compartment (increased pressure around the muscles causing pain) syndrome were considered as diagnostic possibilities. Conservative therapy afforded no relief and imaging studies were negative. A left lower leg fascial release was performed on 1 June 2004, but pain persisted. A magnetic resonance imaging (MRI) of the lumbar spine did not show the back to be the etiology of the pain. At the MEB examination dated 9 February 2005, the CI reported continuous pain which precluded performance of his duties. The MEB physical examiner noted a normal examination other than post-surgery scars on the left leg at the site of the LLE, fascial defect and tattoos. The neurologic evaluation was indicated by a mark to be normal. The non-medical assessment dated 9 February 2005 noted the CI was a hard worker and accomplished all tasks he was assigned, but he was non-deployable. The MEB narrative summary dated 11 February 2005 indicated the CI had chronic pain of an unknown etiology of the left leg status post fasciotomy (anterior compartment). Examination was notable for diffuse swelling and tenderness of the lower extremity in the area of the prior surgery. The neurologic examination was normal. X-rays of the LLE were normal as was a lumbar MRI. As a result of the LLE pain, the CI was unable to run or perform his daily duties as a United States Marine.

At the VA Compensation and Pension examination dated 5 May 2005, performed a month prior to separation, the CI reported pain in the left leg that began in November 2003. Symptoms were reported to occur intermittently and lasted for 2 hours. He applied ice during a flare-up. He denied any bone infection or osteomyelitis and did not use medication. As a result of the “foot condition,” he had difficulty running, prolonged walking and standing, and climbing stairs, but had not missed work because of the condition. The examiner noted a well-healed, mildly tender, dark appearing, level, 5 cm linear scar on the lateral aspect of the distal end of the left shin, without any underlying abnormality or functional impairment. There was no evidence of swelling, erythema (redness) or warmth, but there was tenderness to palpation of the distal LLE at the left calf and the left shin. The knee and ankle joint examinations were normal as was the neurological examination. X-rays of the left tibia and fibula dated 5 May 2005 were negative. Entries in subsequent VA examination records from 2008 and 2010 indicated electro-diagnostic studies of the left lower extremity performed after surgery were normal. The fascial defect was repaired and no muscle involvement was mentioned in the operative report.

The Board directs attention to its rating recommendation based on the above evidence. The Navy PEB assigned a 10% rating using analogous code 5399-5312-8723 (Group XII muscles of the leg and neuralgia, anterior tibial nerve [deep peroneal]) for LLE pain, unknown etiology. The VA likewise assigned a 10% rating using code based on moderate muscle disability status post fasciotomy due to compartment syndrome of the LLE. The Board considered if the scar was separately unfitting. The scar was not specifically referred to the PEB by the MEB nor was it noted as causative of any functional impairment. The Board members agreed that the scar was not a separately unfitting condition. The Board considered the findings and found no route for a higher rating than the 10% rating assigned by both the PEB and VA. 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 left leg 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 left lower leg condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131102, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                          
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review



MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 26 Mar 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

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