RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00867
BRANCH OF SERVICE:  Army	BOARD DATE:  20150417
Separation Date:  20081118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Repair Specialist) medically separated for bilateral shin splints.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral shin splints condition, characterized as “chronic shin splints,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated the bilateral shin splints as unfitting, rated 10% for the right shin and 10% for the left shin, indicating each was rated separately as unfitting, and combined at 20% under a single code IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

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 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:

Service FPEB – Dated 20080812	VA - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints (10% rating for each leg)…	5299-5262	20%	Right Anterior Tibialis Tendonitis	5262	0%*	20080922	
			Left Anterior Tibialis Tendonitis	5262	0%*	20080922	
Other x 0  (Not in Scope)	Other x 3 	
Combined:  20%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20090224 (most proximate to date of separation [DOS])
*VARD dated 20090805 increased the left and right anterior tibial tendonitis to 10% each effective 20081119.

ANALYSIS SUMMARY:

Bilateral Shin Splints Condition.  The CI developed anterior tibial pain while rappelling in 2003, however this slowly resolved.  In June 2007 while running the CI developed reoccurring pain, and he presented approximately 2 to 3 weeks later to the Medical clinic.  The Family Practice provider documented pain to both shins on and off for 3 weeks after running without a history of trauma.  The CI was taking an over the counter non-steroidal anti-inflammatory drug (NSAID) to control the pain.  There were physical exam findings of slight tenderness to palpation to the medial portion of the left tibial shaft.  The examiner diagnosed shin splint and advised to change to a prescription NSAID, a temporary profile for no running and a bone scan was ordered.  A bone scan demonstrated Grade 2 right tibial stress fracture, Grade I left tibial stress fracture severe stress changes in both knees.  The examiner prescribed crutches for weight bearing.  Three months later, a repeat bone scan demonstrated significantly decreased activity in areas of the prior stress fractures which was consistent with healing.  The CI was returned to regular duty, began running again and his pain returned.  Seven months after the second bone scan, a third bone scan demonstrated the return of changes consistent with stress fractures of both tibias.  The CI was given a permanent L3 profile for recurrent bilateral stress fractures and was recommended to report to the Warrior Transition Unit because of his L3 profile.  Although a fourth bone scan demonstrated some interval improvement, his Family Practice provider noted that the CI still had some irritation from the shin splints and if he resumed running his leg pain would return.  The MEB narrative summary (NARSUM) exam accomplished approximately 4 months prior to separation documented that the CI’s pain was not active unless he ran or stood for prolonged periods of time.  The examiner opined that the recurrent chronicity of the pain would be a persistent problem in the future.  The MEB examiner referenced a general physical exam performed on 27 June 2008 which noted being “unremarkable in its character.” (primary document was not present for review by the Board).  The VA Compensation and Pension (C&P) exam is missing from the evidence; however, the VARD dated 24 February 2009 referenced the C&P exam of 22 September 2008 (approximately 2 months prior to separation) which documented an inability to run and limited ability to walk only half a mile without difficulty.  There were physical exam findings of severe tenderness over the right and left lower anterior tibia.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the bilateral shin splints as a residual of tibial stress fractures as 5299-5262 (impairment of tibia and fibula) and rated at a combined 20%.  The PEB specifically documented that the condition was rated as 10% for the right shin splints and 10% for the left shin splints.  The VA coded the left anterior tibialis tendonitis condition as 5262 and rated at 0% for each shin.  The 5 August 2009 VARD increased the left and right anterior tibial tendonitis to 10% each effective 19 November 2008 Shin splints and lower extremity stress fractures are typically rated analogous to 5262 with the disability rating predicated upon slight, moderate, or marked disability.  Both the NARSUM and the VA C&P document pain with increased activity along with relatively asymptomatic periods after decreased activity as would be expected with stress fractures and stress reactions.  This supports a rating of 10% for mild disability for each shin and a combined rating of 20%.  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 bilateral shin splints as a residual of tibial stress fractures evaluated as malunions 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 shin splints as a residual of tibial stress fractures evaluated as malunions 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, 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, AR20150013336 (PD201400867)

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