RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01335
BRANCH OF SERVICE:  Army	BOARD DATE:  20150219
SEPARATION DATE:  20050427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E-1 (Trainee) medically separated for a left leg condition, which could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left leg condition, characterized as “slight frequent left leg pain status-post stress fracture of the tibia,” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic pain, left leg, due to tibial stress fracture” as unfitting, rated 10%, referencing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated. 

CI CONTENTION:  “My injury during my service in the Army makes everyday activities such as running or walking for extended periods of time difficult due to pain.  Sometimes I have pain without trying to run or stand for long periods of time.  The pain is sharp and travels down the front of my leg which is my tibia area.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

 IPEB – Dated 20041101	VA* (12 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
... Left Tibial Stress Fracture	5099-5003	10%	Chronic Shin Splint of Left Tibia	5262	0%	20050427	
Other x 0 (Not In Scope)	Other x 1 	
RATING:  10%	COMBINED RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20050610 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Tibial Stress Fracture.  The narrative summary (NARSUM) and clinical notes indicate that the CI sustained a left tibial stress fracture during basic training, but completed basic training and reported for advanced individual training in September 2003.  Soon afterwards (11 days) she reported to sick call with left tibial pain.  She was diagnosed with a left tibial fracture (managed initially as an inpatient) and placed in a long leg cast for 2 months, which was removed in early January 2004.  Orthopedic progress notes in February and early March document normal gait without bone tenderness.  Restrictions were lifted and the CI resumed training, but a sick call entry later of 31 March 2004 (10 months prior to separation) documents continued pain with “long run, standing longer than 20 minutes, walking, stretches, and direct pressure.”  Follow up X-ray demonstrated a healed stress fracture (cortical thickening, stable on serial studies).

The NARSUM was conducted on 29 September 2004 (5 months prior to separation) and stated, “The tibial fracture healed, but since removing the cast ... the pain [rated “slight, frequent”] persists.  It occurs with any fast walking or prolonged walking and she cannot run at all.  It is greatly increased by impact activities ... only able to walk, bike, or swim at her own pace and distance.”  The NARSUM physical exam documented normal gait, “full” range-of-motion (ROM) of the hips, knees, and ankles, and “moderately tender” over the mid-tibia.

A VA Compensation and Pension examination was conducted on 27 April 2005 (3 months after separation), and noted “sharp pain with movement ... constantly” with limitations of “inability to run, stand greater than 20 minutes, walk greater than 1/4 mile.”  The VA physical exam documented normal gait and “normal findings” of the left tibia and fibula.  Measured ROM of the knee and ankle was normal in all planes, specifying the absence of “pain, fatigue, [or] weakness” with repetitive motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was supported by the USAPDA pain policy (for “slight, frequent” pain); and, IAW DoDI 6040.44.  The VA’s non-compensable rating was under code 5262 (tibia and fibula, impairment), which requires contiguous knee or ankle disability which was not present.  A good clinical fit with this case is provided by code 5022 (periostitis), which defaults to rating criteria of 5003.  The minimum 10% under 5022 is quite defensibly supported by the VASRD §4.40 (functional loss); but, since this would not be advantageous to the PEB code and rating criteria, a recommendation to that effect is not warranted.  There is no other code available under VASRD §4.71a which is applicable to the case, and no path to rating higher than 10% under any code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication of the left tibial stress fracture.

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 was operant in this case; although, its application was supported IAW DoDI 6040.44.  In the matter of the left tibial stress fracture condition (IAW VASRD §4.71a and the USAPDA pain policy), 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130911, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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, AR20150010410 (PD201301335)

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		     
CF: 
(  ) DoD PDBR
(  ) DVA