RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02062
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150213
SEPARATION DATE:  20031016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Electronics Technician) medically separated for left tibial stress fracture (the tibia is the leg bone below the knee).  This condition could not be adequately rehabilitated to meet the requirements of his Rating or physical fitness standards, so he was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The “chronic left tibial stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E, and no other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left tibial stress fracture” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 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:

PEB – Dated 20030804	VA* - (~5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…L. Tibial Stress Fracture	5022-5003	10%	Residuals…Stress Fracture Left…	5262	0%	20040324	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20040430 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Left Tibial Stress Fracture Condition.  Review of the service treatment record revealed a history of recurrent left leg stress fractures that began in November 2000 and caused disenrollment from the SEAL program in 2001.  The unusual nature of persistent pain in 2002 led to evaluation with X-rays, magnetic resonance imaging and CT scanning.  However, no abnormality other than callus formation typical of healing stress fracture of the proximal left tibia was noted.  Despite prolonged treatment with crutch use, casting, activity modification and use of a bone stimulator, there was insufficient improvement.

At the narrative summary evaluation on 21 January 2003 (9 months prior to separation) the CI complained of an inability to run, play sports or walk more than a block without pain.  Anti-inflammatory pain medication provided partial pain relief.  Examination showed joint line tenderness of the left knee and medial tibia.  Knee ligaments were intact.  Recent X-ray showed callus formation (healing bone) of the proximal (near the knee) posterior tibia which was somewhat improved compared to previous studies.

At the VA Compensation and Pension exam performed 5 months after separation, the CI reported pain especially with excessive weight bearing or running.  Examination noted tenderness of the anterior and medial border of the left tibia.  Range-of-motion (ROM) measurements were not performed.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Knee ROM
(Degrees)	PC ~10 Mos. Pre-Sep	MEB ~9 Mos. Pre-Sep	PT ~9 Mos. Pre-Sep	
Flexion (140 Normal)	135	135	“FROM”	
Extension (0 Normal)	0	0	“FROM”	
Comment	Gait normal	+tenderness	+tenderness	
§4.71a Rating	10%*	10%*	10%*	
	*Conceding §4.40 (pain with use) or §4.59 (painful motion)

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under a combined 5022-5003 code (periostitis; degenerative arthritis), while the VA rated the condition 0% using the 5262 code (tibia and fibula, impairment of).  The Board agreed that a 10% rating was reasonably conceded with application of VASRD §4.40 (functional loss) or §4.59 (painful motion), but considered other pathways to a higher rating.  Although there was no radiographic evidence of direct knee joint involvement by the stress fracture, impairment of knee function was possible.  Therefore, consideration of knee ROM coding options is reasonable.  However, limitation of knee motion was non-compensable, thus a higher rating on this basis was not justified.  Under the 5262 code, a 10% rating is warranted for malunion of the tibia with “slight” knee or ankle disability, while the next higher 20% rating requires “moderate” disability.  The Board concluded that the condition was more accurately depicted by the “slight” stipulation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the chronic left tibial stress fracture 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 chronic left 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.

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 20140508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 25 Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)