RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01562
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Health Care Specialist, medically separated for “bilateral tibial stress fractures,” rated 10% and 10%, respectively, with a combined disability rating of 20%. 

CI CONTENTION:  She was given separate ratings by the Army and the VA but the ratings weren’t combined.  The applicant’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 - 20080710	VARD - 20081103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Stress Fractures	5299-5262	20%	Healed Stress Fracture, Left Tibia	5262	0%	20081014	
			Healed Stress Fracture, Right Tibia	5262	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Tibial Stress Fractures.  A bone scan performed on 4 April 2008 revealed bilateral mid-tibial stress fractures as well as bilateral tibial plateau stress changes.  Initial treatment consisted of rest, limitations, physical therapy stretching, and medication.  Despite such treatment, her painful symptoms remained.  She was permanently profiled in June 2008 and referred to a MEB.  Follow-up X-rays on 21 October 2008 (3 months after separation) indicated complete healing of the stress related injury.  At the Medical Evaluation Board (MEB) narrative summary examination (performed on 25 June 2008; a month prior to separation), the CI reported bilateral anterior leg pain aggravated by prolonged standing, walking, and heavy lifting.  Her physical examination revealed bilateral lower leg tenderness.  There was no swelling or redness of either extremity.  Range of motion of both knees and ankles were normal.  At the VA Compensation and Pension examination (performed on 14 October 2008; 3 month after separation), the CI reported an aching and sharp left-sided tibial pain that “travels to her ankle” and aggravated with physical activity.  Her physical examination revealed a normal gait and both lower legs (tibia and fibula) were normal.  The VA’s final diagnosis was bilateral old healed stress fractures of the tibia.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA chose the same primary code 5262 (impairment of tibia and fibula) and rated each leg separately at 10% (20% total) by the PEB citing parameters of functional loss and painful motion, and 0% each leg by the VA citing the absence of a ratable disability.  In reference to examination probative value, Board members agreed that the MEB examination being closer to Service separation was assigned greater probative value in this case.  The Board considered other possible coding options and ratings.  Members considered code 5003 (arthritis) or code 5022 (periostitis) as appropriate to the presenting pathology, but agreed that without incapacitation or limitation in motion, neither code would support greater than the PEB’s current combined 20% disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral tibial stress fracture condition.  

BOARD FINDINGS:  In the matter of the bilateral tibial stress fracture 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 20140401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
SAMR-RB

JUL 2 8 2016

MEMORANDUM FOR Commander, US Army Physical D'lsability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160006754 (PD201401562)

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