MEB for Chronic Exertional Compartment Syndrome (Lower Extremities)

9

91995a

PEB Forum Regular Member
Registered Member
Greetings all!

As of 16 Aug 2024, I have begun the MEB process for bilateral chronic exertional compartment syndrome in my calves. Prior to this MEB submission I had two surgeries (one each leg) to release my anterior and lateral compartments via a fasciotomy. Prior to surgery I attended physical therapy (both aquatic and "out of water") but it did not help, leading me to the surgeries. Unfortunately, after having these surgeries, the symptoms still continue, thus leading to my MEB process. I have read through the forum in regard to some people dealing with the same "issue" I have but have not seen a lot of information on it. I understand that in the 38 CFR that "compartment syndrome" isn't a specific disability, but the muscles/ nerves involved are where the ratings derive from. With that being said, what do the medical providers look at during these C&P exams? What do the ratings look like for this "issue"? If anyone could describe their past experience involving a similar "issue" please let me know!

-Timeline in "about me" section-
 
If you haven't already seen this, check out this Board Of Appeals Docket. It is from 2008, though.

Compartment syndrome (lower extremities) is rated under diagnostic code 5310, based on severity of slight, moderate, moderately severe, and severe.

0% - A "slight" muscle disability contemplates a simple wound of the muscle without debridement or infection; a service department record of a superficial wound with brief treatment and return to duty; healing with good functional results; and no cardinal signs or symptoms of muscle disability. Objectively, there is a minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d)(1).

10% - A "moderate" muscle disability contemplates a through and through or deep penetrating wound of short track from a single bullet, small shell, or shrapnel fragment, without the explosive effect of a high velocity missile, residuals of debridement, or prolonged infection; a service department record or other evidence of in-service treatment for the wound; and a record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. Objectively, there are entrance and if present, exit scars that are small or linear, indicating a short track of missile through muscle tissue; and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2).

20% - A "moderately severe" muscle disability contemplates a through and through or deep penetrating wound by a small high velocity missile, or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring; a service department record or other evidence showing hospitalization for a prolonged period for the wound; a record of consistent complaint of cardinal signs and symptoms of muscle disability; and, if present, evidence of inability to keep up with work requirements. Objectively, there are entrance and (if present) exit scars indicating track of missile through one or more muscle groups; indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscle compared with the sound side; and tests of strength and endurance compared with the sound side demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3).

30% - A "severe" muscle disability contemplates a through and through or deep penetrating wound due to a high velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding, and scarring; a service department record or other evidence showing hospitalization for a prolonged period for treatment of the wound; a record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries; and, if present, evidence of inability to keep up with work requirements. Objectively, there are ragged, depressed, and adherent scars indicating wide damage to muscle groups in the missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in the wound area; muscles swell and harden abnormally in contraction; and tests of strength, endurance, or coordinated movements indicate severe impairment of function when compared with the uninjured side.
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You may want to claim bilateral nerve damage, if you have it. That's a separate rateable condition, as a secondary to bilateral compartment release. Make sure they (va and examiners) DO NOT use the Knee and Lower Leg DBQ. It's the incorrect form. In section 1B under shins splints, it says "compartment syndrome, use Muscles DBQ".

You are going to want an outcome of more than 10% per leg or you won't make the required total of 30% for medical retirement
 
As of last Wednesday, I also started the MEB process for bilateral compartment syndrome. I have had 2 surgeries on my right leg and 1 on my left.
 
Bamcis said:
As of last Wednesday, I also started the MEB process for bilateral compartment syndrome. I have had 2 surgeries on my right leg and 1 on my left.
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Did you have all four of your compartments released on your right leg? I only had the anterior/ lateral compartments released on both of my legs.
 
Update since initial post:

19 Sep 24 C&P exams begin
15 Oct 24 VES requested another report (additional exam)

A few of my DBQs have been uploaded into Tricare Online (Mental Eval, Vision, Audio). Currently waiting on my "head to toe exam" to be uploaded, which from my understanding will take longer due to the amount of claims I have made.
 
91995a said:
Greetings all!

As of 16 Aug 2024, I have begun the MEB process for bilateral chronic exertional compartment syndrome in my calves. Prior to this MEB submission I had two surgeries (one each leg) to release my anterior and lateral compartments via a fasciotomy. Prior to surgery I attended physical therapy (both aquatic and "out of water") but it did not help, leading me to the surgeries. Unfortunately, after having these surgeries, the symptoms still continue, thus leading to my MEB process. I have read through the forum in regard to some people dealing with the same "issue" I have but have not seen a lot of information on it. I understand that in the 38 CFR that "compartment syndrome" isn't a specific disability, but the muscles/ nerves involved are where the ratings derive from. With that being said, what do the medical providers look at during these C&P exams? What do the ratings look like for this "issue"? If anyone could describe their past experience involving a similar "issue" please let me know!

-Timeline in "about me" section-
Click to expand...
I had all 4 compartments released. They did the full cuts. One thing to be aware of is the risk of venous insufficency. Swelling in the toes, feet, ankles. It took about 5 years post surgery for it to start getting unbearable. Terrible swelling if I sit at a desk. Really bad during the summer or in heat. In the future, if you have this issue, claim VI as a secondary. I did that and ended up w 30% per leg (max 40% and requires "stiff as a board") and 10% per leg for nerve damage. Hope this helps.
 
TortolliniShell said:
I had all 4 compartments released. They did the full cuts. One thing to be aware of is the risk of venous insufficency. Swelling in the toes, feet, ankles. It took about 5 years post surgery for it to start getting unbearable. Terrible swelling if I sit at a desk. Really bad during the summer or in heat. In the future, if you have this issue, claim VI as a secondary. I did that and ended up w 30% per leg (max 40% and requires "stiff as a board") and 10% per leg for nerve damage. Hope this helps.
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I only had the anterior/ lateral compartments released (2/4) because those compartments had the highest readings at the time. I have the option to release the other two but idk if that would relieve anything. It's been about 8 months post-op and I still have the same signs/ symptoms as before. I do deal with a lot of swelling, especially standing for long periods of time, sitting long periods of time, and during the summer, much like you said. I'm still in the MEB process so I'm trying to claim as much as I can with these issues.
 
Hi brother, I also on the same boat. MEB started 06/20, C&P done 07/31, MEB file sent to PEB on 10/07, and now I am waiting for PEB decision unfit or fit. good things is I am doing remote Skillbridge/CSP with Allegiant Vet right now while waiting for my MEB to be done, so I dont have to deal with the unreason amount of unit's bs. Hopefully, it will be finished before SB over.
 
Update as of today (13 Nov 24):

04 Nov 24 NARSUM and DA 3947 reviewed with PEBLO
08 Nov 24 Contacted by legal, discussed rebuttal
08 Nov 4 Submitted "Supervisor/Buddy Statements"
13 Nov 24 Received rebuttal packet from legal and sent to PEBLO

As for my rebuttal, I am attempting to add more to my case rather than being rating just for "compartment syndrome". The things I am adding are ankle and knees strains/ swelling as well as back issues due to post surgical recovery.
 
I'm still waiting for PEB decision. My buddy got his after 2 months of his narsum. I have less than a month to that 2 months mark. brother, the path you're taking right now is really long, I hope you stay sane through this process. For me, I have sleep apnea, so I want to finish this quickly and get my rating lock in before they change 50% to 10% for CPAP.
 
Update to my journey thus far. Received 40% from the DoD! Timeline below:

16 Aug 24 P3 Profile Initiated
20 Aug 24 PEBLO made contact
27 Aug 24 Attended IDES brief
28 Aug 24 Initial MEB Counseling with PEBLO
06 Sep 24 Military Service Coordinator (MSC) made contact
09 Sep 24 VA claims submitted/ processed through MSC
19 Sep 24 C&P exams begin
21 Sep 24 C&P exams end
15 Oct 24 VES requested another report (additional exam)
25 Oct 24 all DBQs have been uploaded into Tricare Online
04 Nov 24 NARSUM and DA 3947 reviewed with PEBLO
08 Nov 24 Contacted by legal, discussed rebuttal
08 Nov 4 Submitted "Supervisor/Buddy Statements"
13 Nov 24 Received rebuttal packet from legal and sent to PEBLO
15 Nov 24 Rebuttal denied and case is forwarded to PEB
03 Dec 24 PEB findings (DA199 and VA ratings) received (40% DoD and 100% VA)
 
Congratulation!! on the other hand, still waiting for my DA199, my case is so slow, started in June, va claims closed on 12/3, and still haven't heard anything.. I assume it was delay because of another extra c&p exam on 12/16.
 
Currently in the PEB for compartment syndrome as well. Just wondering if you received your 40% just from CECS? My MEB lawyer and I both think I’m looking at 20% for it. Which I’m fine with.
 
Lifta133 said:
Currently in the PEB for compartment syndrome as well. Just wondering if you received your 40% just from CECS? My MEB lawyer and I both think I’m looking at 20% for it. Which I’m fine with.
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Yes, I was specifically submitted to the MEB solely for CECS. My MEB lawyer gave me her initial estimate of what my ratings would be and she also told me 20% (10% each leg). However, when I received my DA Form 199, I had received 20% each leg (36% plus bilateral factor 3.6 = 39.6% rounded up to 40%). Do you mind sharing your specifics (i.e. have you had surgeries, is it all compartments, have you done physical therapy, etc.)?
 
91995a said:
Yes, I was specifically submitted to the MEB solely for CECS. My MEB lawyer gave me her initial estimate of what my ratings would be and she also told me 20% (10% each leg). However, when I received my DA Form 199, I had received 20% each leg (36% plus bilateral factor 3.6 = 39.6% rounded up to 40%). Do you mind sharing your specifics (i.e. have you had surgeries, is it all compartments, have you done physical therapy, etc.)?
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Also are you having any other issues that are a direct cause from CECS? (shin splints, weakness of ankles, edema, drop foot, etc.)
 
Bilateral, no surgeries, no pt. I claimed that I have nerve damage and ankle problems due to it. But I honestly see myself getting 20%, I’m fine with that due to the severance pay setting my wife and I up for stress free time back in school.
 
Lifta133 said:
Bilateral, no surgeries, no pt. I claimed that I have nerve damage and ankle problems due to it. But I honestly see myself getting 20%, I’m fine with that due to the severance pay setting my wife and I up for stress free time back in school.
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Ah, yeah I would say you will more than likely get the 20% then. Mine was higher due to the fact that I had surgery on both, history of physical therapy, edema (swelling), nerve damage/ numbness, etc. Feel free to DM me on here and I'll help as much as possible if you have anymore questions!
 
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