RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE: PD-2013-00176
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20140227
Separation Date:  20030215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve AOC (PO2)/E-5 (AOC/PO2/Aviation Officer Candidate/Petty Officer 2nd Class) medically separated for a bilateral leg (shin splint) condition.  The CI experienced bilateral shin pain while training in Officer Candidate School.  He was diagnosed with shin splints, was treated conservatively, and returned to training 4 months later.  After another 7 months of training, his bilateral leg pain returned and the condition could not be adequately rehabilitated to meet the physical requirements of his training.  He was referred for a Medical Evaluation Board (MEB).  The bilateral leg/shin pain condition, characterized as “shin splints (tibial periostitis)” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB forwarded no other conditions to the PEB.  The Informal PEB adjudicated “recurrent medial tibial stress syndrome (shin splints)” as unfitting, rated 10%.  The PEB also adjudicated “shin splints (tibial periostitis) chronic” as Category II, a condition which contributes to the unfitting condition and “gastro esophageal reflux disease (GERD)” and “recurrent urolithiasis” as Category III, conditions that are not separately unfitting and do not contribute to the unfitting condition.  The CI made no appeals and was medically.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 recurrent medial tibial stress syndrome (shin splints) condition is addressed below; and, 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 20021122	VA - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Medial Tibial Stress Syndrome (Shin Splints)	5022-5003	10%	Recurrent Bilateral Medial Tibial Stress Syndrome	5022-5262	0%*	Service Treatment Record (STR)	
Chronic Shin Splints	Category II					
GERD	Category III	Duodenal Ulcer Disease	7305	0%	STR	
Recurrent Urolithiasis	Category III	Urolithiasis	7508	0%	STR	
No Additional MEB/PEB Entries	Other x 1	STR	
Combined:  10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20030616 (most proximate to date of separation [DOS])
*VARD dated 20040331 coded each leg 5022-5312 and rated 10% for each effective the day after separation, 20030216

ANALYSIS SUMMARY:  The PEB coded the recurrent medial tibial stress syndrome (shin splints) condition under the single analogous code of 5022, periostitis with 5003, degenerative arthritis.  This coding approach is countenanced by AR 635-40 (B.24 f.), but IAW DoDI 6040.44 the Board must apply only VA Schedule for Rating Disabilities (VASRD) guidance to its recommendation.  The Board must therefore apply separate codes and ratings in its recommendations if compensable ratings for each joint are achieved IAW VASRD §4.71a.  If the Board judges that two or more separate ratings are warranted in such cases; however, it must satisfy the requirement that each “unbundled” condition was reasonably justified as unfitting in and of itself, with the caveat that the final recommendation may not produce a lower combined rating as that of the PEB.

Recurrent Medial Tibial Stress Syndrome (Shin Splints) Condition.  According to the MEB narrative summary (NARSUM) addendum, the CI reported bilateral shin splints on 5 April 2001.  He was seen for pain in the left anterior tibia with physical exam findings of tenderness to palpation (TTP) in the mid left tibia.  The examiner diagnosed mild shin splints and recommended a non-steroidal anti-inflammatory drug Motrin.  The orthopedist documented bilateral leg pain right greater than left; exacerbated by running or walking with significant burning after a half mile and with ambulation on pavement.  The examiner diagnosed bilateral shin splints.  The CI was also evaluated by physical therapy who diagnosed shin splints.  The CI continued with chronic shin splints despite rest.  He was seen in medical clinic with worsening of shin splints with right anterior tibial pain with bruising and left tibial-fibula pain with bruising, mild swelling right tibia greater than left tibia.  The physical exam findings were right tibia-fibula significant TTP anteriorly, midline bone with bruising and swelling; left tibia-fibula TTP midline bone with bruising.  The bone scan demonstrated very slight diffusely increased uptake in the proximal two-thirds of the shaft of the right tibia and fibula consistent with shin splints.  The orthopedics consultation indicated that the CI had pain in the anterior aspects of his legs after approximately a half mile on pavement; however, he also had pain at rest with palpation or stretching.  The physical exam findings were bilateral leg TTP along the anterior crest of the tibia.  The orthopedist diagnosed bilateral shin splints.  The podiatrist noted physical exam findings of mildly tender medial border of the bilateral distal tibia.  The MEB NARSUM exam approximately 5 months prior to separation noted that the CI was on restricted duty since April due to bilateral leg pain and he had been unable to run for 6 months.  The physical exam findings were full range-of-motion in both knees without instability; localized tenderness in the pretibial cortex of the right and left tibias with pain.  An MEB addendum documented recurrent medial tibial stress syndrome.  The non-medical assessment indicated that at the time of this assessment, the CI still experienced pain in his lower legs while running, jumping or walking extensively.  The opinion rendered was that the bilateral leg condition was incompatible with a Navy career.  The CI accomplished a VA Compensation and Pension (C&P) exam 11 months after separation.  That C&P exam was not available for review however, the VARD dated 31 March 2004 referred to that exam and granted the CI separate analogous codes of 5022-5312, Group XII muscle injury, for each and granted a “moderate,” 10%, rating for each leg effective the day after separation.

As noted above, there were no unilateral distinctions with regards to clinical features or fitness considerations.  The commander’s statement did not distinguish between the right and left shins as negatively impacting duty performance.  Therefore, it is reasonable to surmise that it was the overall effect of both lower legs which rendered the CI unfit as determined by the PEB.  It is further noted that a §4.71a basis for individual rating is questionable, given the lack of compensable physical exam findings or differentiation between the shins in the service treatment records.  The bilateral shin pain condition was most compatible with VASRD code 5022 as applied by the PEB.  Evaluating VASRD §4.40 (functional loss) criteria to achieve separately compensable ratings is also quite speculative, since there was no functional loss evidence attributable to a single leg.  Board members agree that there were insufficient grounds for recommending separate right and left leg disability ratings at the time of separation in this case.  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 recurrent medial tibial stress syndrome (shin splints) 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 recurrent medial tibial stress syndrome (shin splints) 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	
Recurrent Medial Tibial Stress Syndrome (Shin Splints)	5022-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

MEMORANDUM FOR DIRECTOR , SECRETARY OF THE NAVY COUNCIL OF REVIEW         BOARDS
Subj:  PHYSICAL  DISABIL ITY           BOARD  OF   REVIEW (PDBR) RECOMMENDATIONS 
Ref:	(a) DoDI 6040.44
(b)	CORB ltr dtd 8 Aug 14

In accordance with reference  (a),    I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective 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, XXX XX XXXX
-	XXXXXXXXXXXXXXX, former USMC, XXX XX XXXX
-	XXXXXXXXXXXXXXX, former USMC, XXX XX XXXX 
-	XXXXXXXXXXXXXXX, former USN, XXX XX XXXX
-	XXXXXXXXXXXXXXX, former USMC, XXX XX XXXX