RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1300001
BRANCH OF SERVICE:  Army	BOARD DATE:  20130502
SEPARATION DATE:  20031105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (77F/Petroleum Supply Specialist) medically separated for right leg pain.  The CI first began experiencing pain in his right lower leg in 2002 while running during basic training.  The leg condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards.  He was therefore issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right leg condition was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The CI did not agree with the MEB and submitted an appeal in the form of requested changes to the MEB narrative summary (NARSUM), which was deemed as insignificant to the case presented to the IPEB and the initial MEB findings were confirmed.  The IPEB adjudicated periostitis, right tibia with leg pain, without limitation of motion as unfitting and rated 0%.  The CI initially requested a Formal PEB (FPEB) and then non-concurred with the IPEB and waived the FPEB.  The US Army Physical Disability Agency (USAPDA) reviewed the case and affirmed the IPEB findings and rating.  The CI was discharged with a 0% disability rating.  The CI submitted an application to the Army Board for Correction of Military Records (ABCMR) which, on review, denied the application in July 2004, with confirmation of the PEB disability rating.

CI CONTENTION:  “Severe depression/serious lower back pain/shint splint/traumatic brain injury/lohbar strain/ right leg stress fracture.”  [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 right leg condition is addressed below.  Low back pain (LBP), traumatic brain injury (TBI), and lumbar strain were not identified by either the MEB or PEB and are therefore not in the 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 consideration by the ABCMR.

RATING COMPARISON:

Service IPEB – Dated 20030723	VA - (6 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Periostitis, Right Tibia with Leg Pain, without Limitation of Motion	5022	0%	Stress Fracture with Shin Splints, Right Tibia	5262	10%	20030521	
No Additional MEB/PEB Entries	Other x 4	20031020	
Combined:  0%	Combined:  30%	

ANALYSIS SUMMARY: 

Right Leg Condition.  The service treatment records indicated the CI reported non-traumatic right leg pain in October 2002 while running.  The CI was unable to complete the run for the final physical training test of basic training.  He was initially diagnosed with shin splints/stress fracture of the tibia and treated conservatively with medications and physical rehabilitation with no reported benefit.  In March 2003, approximately 11 months prior to separation, the CI was evaluated by orthopedic physician who indicated a normal right leg with normal range-of-motion (ROM); diagnosis of periotitis of right lower extremity was made.  All treatment entries indicated full ROM, normal gait, and tenderness to palpation of the right leg.  There was no documented evidence of functional loss of use.  Radiographs indicated stress fracture of right tibia.  A bone scan of the right lower extremity, January 2003, revealed right and left tibias pathology suggestive of chronic stress reaction or possible shin splints.  Whole body bone scan, 12 February 2004, 2 months after separation, reported findings related to ankles and shoulder but none related to tibia.  The CI’s profile allowed him to perform knee bends, calf, thigh, and quad stretches, turn and bounce, single knee to chest, and unlimited walking, biking, and swimming.  At the MEB/NARSUM evaluation 28 April 2003, 7 months prior to separation, the CI noted continued right leg pain without significant relief.  He indicated he could perform the basic activities of daily living but had some discomfort with stair climbing.  He also reported he was able to walk and do the other activities of military training other than running for physical training.  On physical examination, there was no evidence of inflammation, muscle atrophy, neurological deficits, or decrease muscle strength.  ROM was full, there was tenderness in the right tibia, and also slight tenderness in the left; reflexes were slight reduced bilaterally.  Sensation was intact and gait was normal.  VA Compensation and Pension evaluation, 21 May 2003, approximately 4 months prior to separation, the CI reported left and right tibia stress fractures and shin splints with pain in both legs.  Physical examination recorded normal gait, ROM flexion of 140 and extension of 0 in both extremities, and absence of limitation of motion by pain, fatigue, weakness, or lack of endurance or incoordination.  The examiner also noted normal radiographic findings of left tibia and fibula.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated right leg pain condition at 0% under code 5022 (periostitis) for pain, while the VA rated the right leg condition at 10% as 5262 (impairment of tibia) citing chronic pain of right leg.  A higher rating under the 5022 code requires radiographic evidence affecting two or more joints or limitation of motion, neither of which the records support.  The Board considered §4.59; however, there was no documented evidence of painful motion.  The Board examined whether §4.40 functional loss would apply and concluded the CI’s profile did not support the use of this code; The CI could perform activities of daily living, had normal ROM without limitation with pain, and overall, no significant loss of functioning.  There were no other applicable VARSD codes to a higher rating.  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 right 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 periostitis right tibia 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Periostitis, Right Tibia With Leg Pain	5022	0%	
COMBINED	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121228, 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 AR20130010949 (PD201300001)

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