RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00384
BRANCH OF SERVICE:  AIR FORCE		SEPARATION DATE:  20070604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces, medically separated for “soft tissue inflammation, shin splints, feet and ankle pain,” with a disability rating of 10%.

CI CONTENTION:  The CI elaborated no specific contention in her application.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:

SERVICE PEB - 20070418	VARD - 20070828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Soft Tissue Inflammation of both Lower Extremities due to Repetitive Trauma, 
evidenced by Right Shin Splint, and Stress changes in Bilateral Feet and Ankles	5022	10%	Left Ankle Strain and Stress Reaction with Plantar
Fasciitis	5271	10%	20070711	
			Right Ankle Strain and Stress Reaction with Plantar
Fasciitis	5271	10%	20070711	
			Bilateral Shin Splints	5099-5020	NSC	20070711	
			Soft Tissue Inflammation, Bilateral Lower Extremities	5099-5020	NSC	20070711	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Soft Tissue Inflammation of both Lower Extremities.  In August 2006, the CI experienced pain in both lower extremities (LEs).  Radiologic imaging showed a right shin splint, and diffuse evidence consistent with stress changes in both feet and ankles.  She was unable to adequately perform her military training and a Medical Evaluation Board (MEB) was initiated.  The MEB narrative summary (NARSUM) dated February 2007, 3 months before separation, was performed by orthopedics.  The CI reported bilateral lower extremity (LE) pain and the inability to return to running.  The CI was in no acute distress and gait was normal.  Range of motion (ROM) for both feet was “excellent.”  Both ankles were tender to palpation but dorsiflexion and plantar flexion strength testing was normal.  Ankle ROM was dorsiflexion 15 degrees (20 normal) and plantar flexion 40 (45 normal).  The examiner opined based on the early onset of symptoms during a course of her basic training and early Air Force career [Security Forces] that she would be able to perform activities required of normal military service.  She was diagnosed with bilateral foot and ankle pain.

During the VA Compensation and Pension (C&P) exam in July 2007, a month after separation, the CI reported constant pain in both LEs.  Due to the pain, she had difficulty with walking or standing for extended periods of time.  On physical examination, the CI was in no acute distress and gait was normal.  Both bilateral tibia and fibula were normal.  Both ankles revealed no evidence of edema, effusion, weakness, tenderness, redness, heat, subluxation, guarding of movement, or deformity.  Her ROM was painful for dorsiflexion 15 degrees and plantar flexion 35.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned one 10% rating coded 5022 (periostitis) by bundling the two LEs as a single unfitting condition.  The VA assigned two 10% ratings coded 5271 (ankle, limitation of motion) to the left and right ankles with stress reactions and plantar fasciitis.  The Board evaluated whether or not it was appropriate for the two legs (lower extremities) to be “bundled” together.  The Board must determine if the PEB’s approach of combining the legs under a single rating was reasonably justified in lieu of separate ratings.  The Board must apply separate ratings in its recommendation if compensable ratings for each leg are achieved IAW the VASRD.  If the Board judges that two or more separate ratings are warranted; however, it must satisfy the requirement that each “unbundled” condition was separately unfitting.  After due deliberation, the Board agreed that the evidence supports a conclusion that each of the legs problems, separately, would have rendered the CI unable to perform her required military training.  Therefore, the Board recommends a separate disability rating for the left and right legs (lower extremities).

The Board also deliberated on whether or not the lower extremity foot pain should be unbundled from ankle pain for each leg.  The Board determined that, based on the evidence in the record, it is appropriate for the foot pain to be bundled with ankle pain, and treated as a single unfitting condition for each leg.  The Board determined that, IAW VASRD §4.10 (functional impairment), §4.40 (functional loss), and §4.59 (painful motion), when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional loss and disability due to pain.  There was no path to a higher rating for either leg, since there was insufficient evidence of a seriously bone or joint abnormality that would justify a higher rating.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board determined that a disability rating of 10% for the left lower extremity and 10% for the right lower extremity was appropriate.

BOARD FINDINGS:  In the matter of the soft tissue inflammation, the Board unanimously recommends a disability rating of 10% for the right leg and 10% rating for the left leg, IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Soft Tissue Inflammation of the Right Lower Extremity	5022	10%	
Soft Tissue Inflammation of the Left Lower Extremity	5022	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131223, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR 
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00384.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR