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AF | PDBR | CY2014 | PD 2014 00103
Original file (PD 2014 00103.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00103
BRANCH OF SERVICE: Army  BOARD DATE: 20141114
SEPARATION DATE: 20070614


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (27D/Paralegal) medically separated for bilateral exertional compartment syndrome. 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 bilateral exertional compartment syndrome condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “bilateral exertional compartment syndrome, status post fasciotomies, left leg” as unfitting rated 0%, with applicatio n of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I have more Issues walking/running than I did when I was separated. I only have 0 percent for the reason I was separated and I have the problem in both Legs!” [sic]


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 exertional compartment syndrome condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any condition 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 Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his bilateral leg conditions continue to burden him; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws.


 RATING COMPARISON :

Service IPEB – Dated 20070312
 VA* - (<1 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Exertional Compartment Syndrome, status post Fasciotomies, Left Leg 5399-5312 0% Status-Post Fasciotomy to the Left Leg with Residual Scar 5020-7804 0% 20070628
Compartment Syndrome, Right Leg 5099-5020 NSC 20070628
Other x 0 (Not in Scope)
 Other x 11
Combined: 0%
 Combined: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 71017 (most proximate to date of separation )

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment and worsening severity with which his service-incurred condition continues to burden him. It is a fact, however, that the DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. This role and authority is granted by Congress to the Veterans Affairs. The Board utilizes VA evidence proximal to separation in arriving at its recommendations and DoDI 6040.44 defines a 12 months interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Bilateral Leg Condition. In June 2003, the CI underwent evaluation for complaint of bilateral leg pain that’s exacerbating while running. He was diagnosed with exertional compartment syndrome based on exercise pressure monitoring (compartment syndrome occurs when tissue pressure within a closed muscle compartment exceeds the surrounding blood flow pressure…possibly resulting in muscle and or nerve damage). The CI underwent anterior and lateral compartment fasciotomies (surgical opening of the muscle compartment) of the left leg in August 2003 with no long-term relief of symptoms. Complaints of similar exertional symptoms affecting the right leg developed and pressure testing performed in March 2007 confirmed a diagnosis of compartment syndrome. Although surgery was offered, it was declined by the CI due to prior “unsuccessful surgery” on the left leg.

At the time of the MEB narrative summary (NARSUM) dated 07 February 2007 (4 months prior to separation) the CI’s primary complaint was bilateral leg pain. He reported an inability to run, ruck-march, or conduct a 3-5 second rush fighting position. The physical examination revealed bilateral lower anterior leg pain with repeated heel lifts (a cursory clinical test simulating “exercise”) which correlated with the distribution of the left superficial peroneal nerve. The vascular examination was normal. There was a well healed nine centimeter longitudinal scar over the front aspect of the left leg. His pain rating was described as “constant and slight”.

At the VA Compensation and Pension (C&P) exam obtained on 28 June 2007 (2 weeks after separation), the CI stated that he has bilateral shin pain that he described as a squeezing, burning, aching, sharp and cramping pain, which occurs daily and each episode lasting an hour. The CI also stated that the pain is easily elicited by physical activity and relieved with rest and anti-inflammatory medication. “At the time of pain [the CI] can function with medication”. The VA physical exam was detailed and normal. The examiner specifically noted that in regards to the left leg, there was subjective pain and objectively, a scar. The right leg rendered no abnormal pathology as to render a diagnosis. The CI continued in his usual occupation as a paralegal. The impacts of the condition on the CI’s usual occupation and daily activities were noted as “none” and “limited”, respectively.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition under analogous VASRD primary muscle code 5399-5312 and invoked the USAPDA pain policy as the basis for its 0% rating. The VA separately rated the left leg for residual surgical scars at 0% and right leg as not service connected. In light of two examinations with different physical findings, Board members first discussed the degree of probative value between the NARSUM and the VA exam and agreed that exclusive probative value be assigned to the VA exam, being detailed in its assessment and occurring nearest to separation. Although the CI continued with subjective adverse symptoms, his evaluation near separation was completely normal in both lower extremities; revealing only the evidence of a surgical scar. Members agreed that neither leg condition (individually or combined) manifested any degree of functional impairment near the time of separation and therefore, there is no clinical approach for a rating greater than the PEB’s current 0%. 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 condition.

Residual Surgical Scar. By precedent, the Board does not recommend disability rating for scars unless their presence imposes a direct limitation on fitness. The fact that the CI had residual scarring does not automatically result in disability compensation. It is clear that the scarring alone did not limit his ability to perform as all the medical and performance data supported the fact that the applicant had no physical limitations imposed on his assigned duties. Board members unanimously agreed that the scar condition cannot be recommended as unfit for additional disability rating.


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 bilateral leg conditions was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the bilateral leg condition and IAW VASRD §4.71a, §4.120, and §4.73, 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131225, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                 
XXXXXXXXXXXXXXX
President
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, AR20150003757 (PD201400103)

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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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