RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1300037
BRANCH OF SERVICE:  Army	BOARD DATE:  20120606
SEPARATION DATE:  20020914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (88M/Motor Transport Operator) medically separated for a chronic right leg condition.  The right leg condition began in Basic Training in 1999.  The leg could not be adequately rehabilitated to meet the physical requirements of being a Soldier; however, her commander’s letter indicated that “the soldier is still seemingly able to perform her daily duties as an 88M10.”  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right leg condition, characterized as stress fracture of the posteromedial aspect of the one-third tibial shaft was forwarded to the Physical Evaluation Board (PEB).  No other conditions were submitted by the MEB.  The PEB adjudicated chronic right leg pain due to stress fracture of the posteromedial aspect of the one-third tibial shaft as unfitting, rated 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “Chronic reoccurrence of the following medical conditions:  right tibia stress fracture, hemorrhoids, hearing loss, femur stress fracture and mid/low back pain.  Medical records can be retrieved from the VA Nashville hospital and Blanchfield Army Community Hospital (Ft. Campbell, KY) in order to confirm and establish chronic complaints with all 5 medical conditions.”  The CI closes in block 15, remarks, with:  “All 5 conditions in which I was rated for 10 years ago have not improved, but has gotten progressively worse with time and as I grow older the conditions hinder my overall quality of life.”

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 tibia stress fracture condition is addressed below.  The contended conditions of hemorrhoids, hearing loss, and mid/low back pain are not within the DoDI 6040.44 defined purview of the Board.  These and 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.

RATING COMPARISON:

Service IPEB – Dated 20020703	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Leg Pain to Stress Fracture of the 1/3 Tibial Shaft	5099-5003	10%	Right Tibia Stress Fracture	5021	10%	STR	
No Additional MEB/PEB Entries	Other x 1	STR	
Combined:  10%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20020914 (most proximate to date of separation)

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System 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 Veterans Affairs, operating under a different set of laws.

Chronic Right Leg Pain Condition.  The CI first presented for pain in both lower extremities (BLE) in May 1999, 3 months after accession.  She was treated for bilateral femoral stress reactions and then left lower extremity stress reaction over the course of the next few years with apparent resolution.  She also had multiple muscle strains in BLE.  She sought treatment on 29 August 2001 for right lower extremity (RLE) pain.  The CI reported, on this occasion, that she had been experiencing pain for 4 months “off and on” and swelling in her RLE.  The CI reported that physical therapy (PT) and rehabilitation in the past had not been helpful.  The examiner noted tenderness to palpation (TTP) of the anterior leg, but noted no swelling.  The examiner referred the CI to PT; ordered an X-ray and a bone scan; and prescribed a non-steroidal anti-inflammatory drug (NSAID).  The CI returned for a follow-up appointment on 14 September 2001 and reported that she had reinjured her RLE “stepping in a ditch.”  The examiner assessed RLE stress fracture and placed the CI temporary profile.  The radiology reports were not in evidence; however, the primary care note on 12 October 2001, reported that the bone scan “indicates stress fracture of the posterior medial aspect of the right proximal 1/3” of the right tibia.  On 23 October 2001, an orthopedic examination revealed TTP along the anterior and medial aspect of the right tibia.  The orthopedist noted that the X-ray of the tibia and fibula was negative, but the bone scan revealed increased uptake consistent with a fracture.  The history of multiple previous stress fractures was noted.  The examiner’s impression was that this condition was “non-surgical” and the CI was “unfit for duty.”  The CI was permanently profiled for the right tibia stress fracture and she was determined to be unfit for duty.  Her bone density was found to be normal when tested on 23 January 2002.  The MEB narrative summary, dictated 3 June 2002, 3 months prior to separation, stated that the CI reported right leg pain since her basic training in 1999.  The pain was increased with weight bearing and running.  The MEB physical examination, performed 6 months previously on 26 December 2001, noted that the CI was 65 inches tall and weighed 128 pounds.  The examiner reported that the CI’s motor strength was normal “5/5 diffusely,” deep tendon reflexes were normal (2+), and the sensory examination was intact.  The radiographic reports are discussed above.  The commander’s statement reported that the CI’s condition was permanently profiled and impacted her ability to participate in physical training; however, the commander stated “the soldier is still seemingly able to perform her daily duties as an 88M10,” but noted that her ailments may interfere with physical training or extreme strenuous activity.  There was no VA Compensation and Pension exam; the VA used the service treatment records for the VARD.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB analogously coded the chronic right leg pain 5099-5003 with a 10% disability rating.  The VA coded the right leg pain condition 5021 (myositis) and also assigned a 10% disability rating.  The Board agreed that there was no other compensable route to a higher rating for the chronic right leg pain condition than the 10% 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 chronic right leg pain 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.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic right leg pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right leg pain 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	
Chronic Right Leg Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130101, 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 AR20130016373 (PD201300037)

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