RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02359
BRANCH OF SERVICE:  Army	BOARD DATE:  20150428
SEPARATION DATE:  20070323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Preventive Medicine Specialist) medically separated for bilateral shin splints.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral shin splints” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (hypertension) for PEB adjudication.  The Informal PEB adjudicated “bilateral shin splints” as unfitting, rated 0%.  The hypertension condition was determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests that the Board review all conditions.  His complete submission is at Exhibit A.  

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:  

IPEB – Dated 20070305	VA* - (~10 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints	5022	0%	Shin Splints	5299-5262	NSC	20080122	
Hypertension	Not Unfitting	No VA Entry	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  No VA Rating 	
*Derived from VA Rating Decision (VARD) dated 20080729 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Shin Splints.  The narrative summary (NARSUM) noted that the CI had chronic bilateral shin pain related to running and stair climbing.  Profile restrictions, soft shoes, and anti-inflammatory medications did not resolve symptoms.  Plain X-rays were normal with a bone scan documenting bilateral shin splints without stress fractures.  Exam documented normal gait with normal appearing shins.  There was bilateral tenderness over the shins (anterior lateral border of the tibiae) with no edema or skin changes.  Strength, sensation and pulses were normal.  Follow-up assessment noted that both knees and ankles had full range-of-motion.  

At the VA Compensation and Pension  exam performed 10 months after separation, the CI reported shin splints after running and jogging.  He could avoid shin splints with slow jogging and had no impairment with “walking even at a quick pace.”  Exam documented a normal gait and normal neuromuscular exam.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition as 5022 (periostitis) at 0% stating "without limitation of motion."  The Board deliberated if the CI’s bilateral shin splints warranted a rating of 10% analogous to 5022 for “X-ray evidence of involvement of 2 or more major joints; however, the Board consensus was that no specific joints were involved.  There was no documented painful or limited motion of the knees or ankles and no evidence of incapacitating episodes, fractures, or muscle injury in the lower legs.  Alternative coding analogous to 5262 (tibia and fibula impairment) was considered; however, there was no malunion of the tibia (bad healing after a fracture) and there was insufficient evidence to indicate at least “slight knee or ankle disability.”  Therefore, alternative coding analogous to 5262 would be at 0% for each side IAW VASRD §4.31 (A no-percent rating).  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 shin splints condition.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

There were scant treatment records in evidence.  The NARSUM indicated the CI claimed he had hypertension prior to entering the Service (no entry physical was in evidence).  At the time of the NARSUM and VA exams, the CI was not taking any anti-hypertensive medication.  There was no evidence of any hypertension-related end organ disease or damage.  The blood pressures at the VA exam averaged below the normal cut-off values for diagnosing hypertension [systolic 140 and diastolic 90 mm Hg].  The hypertension condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  Hypertension was reviewed and considered by the Board.  There was no performance based evidence from the record that hypertension significantly interfered with satisfactory duty performance.  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 contended hypertension condition and so no additional disability rating is recommended.  

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.  In the matter of the bilateral shin splints condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140522, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20150018412 (PD201402359)

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