RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01307
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060405

Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “right tibial stress fracture, left tibial stress reaction and right greater trochanteric bursitis,” all rated at 0%, with a combined disability rating of 0%.

CI CONTENTION:  The CI contends she was not evaluated for back, depression and migraine headache conditions incurred during her military service.  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 - 20060309	VARD - 20060706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibial Stress Fracture	5099-5022	0%	Residuals, Right Tibial Stress Fracture	5262	NSC	20060316	
Left Tibial Stress Reaction	5022	0%	Residuals, Left Tibial Stress Fracture	5262	0%	20060316	
Right Greater Trochanteric Bursitis	5019	0%	Right Hip Sprain	5252-5019	10%	20060316	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Tibial Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right tibial stress fracture condition began 2000 during training.  The CI remained on a P2 profile until June 2005 when she presented with right mid-tibial pain radiating to the foot after prolonged walking.  Radiographic studies showed degenerative disease of the right tibiotalar joint.  There was no surgical indication. Despite treatment, the right lower extremity pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded persistent pain status post stress fracture of the right tibia for PEB adjudication.  The NARSUM examination 01 January 2006 documented of right tibial pain with radiation to the foot after walking or standing.  The physical examination demonstrated right greater than left tibial shaft tenderness to palpation.  At the VA Compensation and Pension (C&P) examination performed less than 1 month before separation, the CI reported persistent right tibial pain.  The physical examination demonstrated a normal gait, tibia and fibula examination, and right ankle and knee range of motion (ROM).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right tibial stress fracture at 0%, coded 5099-5022 (analogous to periostitis) citing no joint involvement.  The VA did not service connect the condition.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for the knee or ankle.  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 right tibial stress fracture condition.  
 
Left Tibial Stress Reaction.  According to service treatment records and the MEB NARSUM, the CI’s left tibial stress fracture condition began 2005.  Radiographic studies showed degenerative disease of the left tibiotalar joint and tibial stress changes.  There was no surgical indication. Despite treatment, the left lower extremity pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded left tibia stress reactions for PEB adjudication.  The NARSUM examination 01 January 2006, 3 months prior to separation, documented of left tibial pain.  The physical examination demonstrated right greater than left tibial shaft tenderness to palpation.  At the VA C&P examination performed less than 1 month before separation, the CI reported persistent right tibial pain.  The physical examination demonstrated a normal gait, tibia and fibula examination, and right ankle and knee ROM.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left tibial stress fracture at 0%, coded 5022 (periostitis) citing no joint involvement.  The VA left tibial stress fracture at 0%, coded 5262 (tibia and fibula, impairment of) citing the absence of malunion of the tibia and fibula with a slight ankle disability.  The Board placed higher probative value on the VA examination based on its proximity to separation.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for the knee or ankle.  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 left tibial stress fracture condition.

Right Greater Trochanteric Bursitis.  According to STR and the MEB NARSUM, the CI’s right greater trochanteric bursitis condition began 2005.  There was no surgical indication.  Despite treatment, the right greater trochanteric bursitis condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  
The MEB forwarded right greater trochanteric bursitis for PEB adjudication.  The NARSUM examination 01 January 2006, 3 months prior to separation, documented reports of persistent right hip pain.  The physical examination demonstrated pain limited internal rotation and mild tenderness of the greater trochanteric area.  At the VA C&P examination performed less than 1 month before separation, the CI reported persistent right hip pain.  The physical examination demonstrated a normal gait.  There was decreased right hip flexion to 95 degrees (normal 125 degrees).  There was no additional limitation by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right greater trochanteric bursitis at 0%, coded 5019 (bursitis) citing only one joint involved.  The VA right hip strain at 10%, coded 5252-5019 (thigh, limitation of flexion of-bursitis) citing reports of pain with limitation of flexion.  The Board placed higher probative value on the VA examination based on its proximity to separation.  There was evidence of subjective reports of pain with use and objective evidence of right hip limitation of motion supporting a 10% rating for functional loss based on §4.40. 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 right greater trochanteric bursitis condition.

BOARD FINDINGS:  In the matter of the right tibial stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left tibial stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right greater trochanteric bursitis condition, the Board unanimously recommends a disability rating of 10%, coded 5019 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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	
Right Greater Trochanteric Bursitis 	5019	10%	
Right Tibial Stress Fracture	5099-5022	0%	
Left Tibial Stress Reaction	5022	0%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140306, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160010066 (PD201401307)

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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization 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