RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-01047
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “atraumatic onset of bilateral anter1or shin pain…” with a disability rating of 20%.  

CI CONTENTION:  “Inability to perform certain cardiovascular exercises that led to overweight problems.  In order to lose weight I've had to submit to extreme painful diets and fasting in order to reduce weight.  I've had to conform to low paying jobs due to my inability to perform heavy duty tasks that required heavy lifting or cardiovascular activities like running.  The pain in my legs continues even though I tried for years to let my legs rest.”  “I was granted 10% for scars under my right arm caused by surgical procedures done at the ARMY facilities.”  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 – 20080922	VARD – 20090304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atraumatic Onset of Bilateral Anterior Shin Pain	5099-5022	20%	Shin Splint Right Leg	5299-5262	0%	20090113	
			Shin Splint Left Leg	5299-5262	0%	20090113	
			Bilateral Stress Fracture, Resolved Per Bone Scan	5299-5262	NSC	20090113	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Anterior Shin Pain.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) dated 12 August 2008 indicated the CI developed bilateral anterior shin pain during basic training in August 2005; however, the CI was able to complete training.  Examination in January 2006 revealed tenderness to palpation of the mid shins with mild edema (swelling) over the mid shins of the anterior tibia bilaterally; and, a temporary profile was issued.  Change of shoes was recommended and naproxen (a nonsteroidal anti-inflammatory drug (NSAID)) was prescribed in May 2006.  X-rays of the right and left tibias dated 11 August 2006 showed subtle undulating contour changes of the medial cortex (outer portion) of the midsection of the tibia, which represented either a normal variation or periosteal (outer covering) bone growth due to overuse injury.  A bone scan performed on 12 September 2006 revealed patchy increased bone uptakes along the cortex of both tibias, predominantly in the area of the proximal lateral (outside) border, which suggested a stress reaction.  A bone scan in November 2007 showed stress changes of both knees and ankles without evidence of stress fractures; however, there were no focal abnormalities throughout the remaining bony structures of the lower extremities, but bilateral shin pain continued to the point where the CI was unable to perform required activities.  

At the MEB examination dated 2 January 2008, the CI reported on DD Form 2807-1, Report of Medical History, “the stress fracture in my legs created that problem on my knees and ankles” and there was no improvement with medicine, physical therapy, and profiles.  The MEB physical examiner noted on DD Form 2808, Report of Medical Examination, no abnormal findings for the lower extremities, but listed bilateral tibial stress fractures in the summary of defects and diagnoses.  A permanent L3 profile was issued on 11 August 2008 for chronic shin splints with limitations of moving with a fighting load and doing rushes under direct and indirect fire.  Additional restrictions included no two mile run for the physical fitness test and lower body physical training at the CI’s own pace and distance.  

The NARSUM examination was based on the MEB physical examination dated 28 July 2008.  There was a full range-of-motion (ROM) at all joints without any erythema, edema, or tenderness to palpation.  There was mild tenderness to palpation along the medial aspect of the middle third extending to the distal third of the tibias (shins) bilaterally.  Knee and ankle examinations were normal.  Gait was normal as was strength of the lower extremities.  Neurologic examination was unremarkable.  The NARSUM noted the CI reported no significant pain at rest; however, with activity he had significant pain along the bilateral anterior, medial, center one-third of the shins.  As a result of the pain he was unable to run or walk long distances.  The undated commander’s statement indicated the CI had permanent shin splints/fracture, and he could perform basic soldier tasks, but could not run for physical training and could only carry minimum loads.

At the VA Compensation and Pension (C&P) examination dated 13 January 2009, performed 2 months after separation, the CI reported as long as he was sedentary and not doing a lot of activity his shins did not hurt; however, a month earlier he did a lot of walking, including walking up hills, and noticed worsening pain in both shins, which was treated with rest and ibuprofen (an NSAID); improvement occurred in 4 to 5 days.  On examination the lower extremities were normal except for palpable tenderness over the medial aspects of the tibias and mild crepitus of the knees; however, there was a full ROM of the hips, knees, and ankles.  All motions were without pain and all remained the same after repetitive motion. Neurologic evaluation was unremarkable.  Bone scan imaging dated 9 February 2009 revealed no manifestations of shin splints or stress fractures over each tibia and fibula; and, X-rays in July 2009 showed no evidence of soft tissue or bony abnormalities.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating for bilateral anterior shin pain using code 5099-5022 (periostitis) broke down the rating to 10% for the right and 10% for the left for satisfactory evidence of pain with use.  The VA assigned a 0% rating for a shin splint of the right leg using code 5299-5262 (tibia and fibula impairment) and a 0% rating for a shin splint of the left leg using code 5299-5262.  The Board sought a route to a higher rating and noted that code 5022 “will be rated on limitation of motion of affected parts, as arthritis, degenerative” IAW with VASRD code 5003.  Since the PEB indicated a 10% rating for the right lower extremity and a 10% rating for the left lower extremity, the Board did not have to perform uncoupling of a PEB consolidated rating.  However, the Board was unable to find evidence to support a higher rating for either extremity in the absence of moderate knee or ankle disability, limitation of flexion to 45 degrees or extension to 15 degrees, any cartilage defects, knee impairment, or ankylosis.  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 anterior shin pain condition.

BOARD FINDINGS:  In the matter of the bilateral anterior shin pain 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.  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 20140225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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 XXXXXXXXXXXXXXXXXXXX, AR20160007459 (PD201401047)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA