RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01332
BRANCH OF SERVICE:  Army	BOARD DATE:  20141021
SEPARATION DATE:  20090505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve PV1/E-1 (Basic Trainee) medically separated for bilateral stress fractures.  The bilateral stress fractures could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral stress fractures, characterized as “chronic bilateral leg pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral tibial stress fractures” as unfitting; each rated 10% for a combined rating of 20%.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting bilateral stress fractures is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20090407	VA - (3.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibial Stress Fractures	5299-5262	20%	Right Tibial Stress Fractures	5200-5262	10%	20090817	
Left Tibial Stress Fractures	5299-5262		Left Tibial Stress Fractures	5299-5262	10%	20090817	
Other x 0  (Not in Scope)	Other x 0 (Not in Scope)	20090817	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20090916 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Bilateral Stress Fractures Condition.  The narrative summary notes the CI developed bilateral lower leg pain during basic training.  A bone scan performed in November 2008 diagnosed bilateral tibial plateau and mid shaft tibial stress fractures.  The CI was placed on convalescent leave for 30 days and was returned to duty in January 2009.  The pain immediately returned and continued to worsen despite physical therapy and a MEB was recommended by the orthopedic consultant.  Bilateral leg X-rays on 14 January 2009 noted chronic stress changes along both tibiae.

At the MEB examination performed on 12 March 2009, 2 months prior to separation, the CI reported constant pain in both lower legs increased by weight bearing activities.  The MEB physical exam noted a normal gait.  Right knee range-of-motion (ROM) was extension-flexion of 0 degrees – 137 degrees (normal 0 degrees -140 degrees); left knee ROM was 0 degrees – 135 degrees, both with pain on flexion.  There was no swelling of the knee or joint line tenderness.  There was no instability, laxity or evidence of cartilage injury.  There was tenderness to palpation of the anterior lower legs bilaterally.  Evaluation of the bilateral feet and ankles was normal, except for minimally decreased plantar flexion of the left ankle, with painful motion noted.  Lower extremity (LE) muscle strength was normal bilaterally.

At the VA Compensation and Pension examination performed 3 months after separation, the CI reported anterior pain of both lower legs aggravated by weight bearing activities.  On examination there was tenderness to palpation of the tibiae bilaterally without abnormalities of any bone or weight bearing joint.  The examiner noted the CI was enrolled in school and employed full-time at a sedentary job and indicated the current level of disability was “mild or low.”

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated tibial stress fractures of the right and left leg 10%, coded 5299-5262 (analogous to impairment of the tibia/fibula for shin splints).  The Board noted that the CI was diagnosed by bone scan with tibial stress fractures of both legs just under the knee (tibial plateau) and in the middle of the tibia.  The CI experienced pain, especially with weight bearing activities.  There was no evidence of any knee, ankle or foot injury of either LE.  The PEB indicated rating of the stress fractures was based on painful motion (VASRD §4.59, painful motion) and the VA noted slight knee disability, presumably due to the noted pain with flexion of both knees.  The Board considered if there was any path to a higher rating of either stress fracture condition but agreed that the disability of each leg was due to pain alone.  Therefore, even if an alternative code was utilized, such as 5099-5019 (periostitis), the rating would be 10% for each leg for painful motion and there was no evidence in the record of any other ratable impairment of the legs.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral tibial stress fractures.

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 tibial stress fractures 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 20140423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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, AR20150007676 (PD201401332)

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			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA