RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00293
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Network Switching Systems Operator) medically separated for bilateral shin splints.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  The “shin splints” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “shin splints” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  He was given a higher rating for his conditions by the VA.  His complete submission is at Exhibit A.

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 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 20010626	VA* - (~1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Shin Splints	5022	0%	Shin Splints, Left Lower Extremity with History of Stress Fractures	5022	10%	20030728	
			Shin Splints, Right Lower Extremity with History of Stress Fractures	5022	10%	20030728	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 (equals SC, NSC & deferred)	
RATING:  0%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20030825 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:   

Shin Splints Condition.  The CI initially presented during basic training with bilateral leg pain.  A bone scan performed 12 September 2001 revealed a Grade 3 right tibial stress fracture and stress reaction in the left tibia.  The CI was treated with activity modification, physical therapy, and anti-inflammatory medications.  The CI continued to report bilateral lower extremity pain which increased with activity and was placed on 2 weeks of crutch ambulation in January 2003.  At the narrative summary (NARSUM) examination, the CI reported bilateral lower extremity pain with physical activity.  The examiner documented radiographic results which showed right shin splints and no evidence of bilateral lower extremity stress fractures.  The NARSUM physical examination demonstrated bilateral tibial tenderness to palpation.  A diagnosis of shin splints was rendered.  At the VA Compensation and Pension (C&P) examination performed one month before separation, the CI reported constant, sharp lower extremity pain with walking.  He rated the pain 5/10.  The physical examination demonstrated a normal gait and bilateral tibia/fibula tenderness to palpation.  A diagnosis of bilateral shin splints was rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting bilateral shin splint condition at 0% for slight muscle impairment; coded 5399-5310 (analogous to foot muscle injury).  The VA rated the bilateral shin splint condition at 10% for each lower extremity; coded 5022 (Periostitis).  As noted above, the PEB combined both lower extremities under a single disability rating.  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant with VASRD rating criteria, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed that each lower extremity is separately unfitting and that identical coding and ratings are applicable.  The Board noted that multiple treatment notes and the NARSUM and VA examinations documented subjective reports of bilateral lower extremity pain with use and objective findings of tenderness to palpation.  Board members agreed that the evidence supports a 10% rating for each lower extremity, IAW VASRD §4.40 (Functional loss).  There was no evidence of leg limitation of motion or incapacitating episodes for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the each left for the bilateral shin splint 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 bilateral condition, the Board unanimously recommends a disability rating of 10% for each lower extremity, coded 5022 IAW VASRD §4.71a.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Shin Splint 	5022	10%	
Right Shin Splint	5022	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140104, 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 XXXXXXXXXXXXXXXXXXXXXXXXX, AR20160000205 (PD201400293)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA