RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03682
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Public Affairs Craftsman, medically separated for “bilateral shin splints,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20081114	VARD - 20090630  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints	5299-5262	10%	Bilateral Shin Splints	5299-5024	0%	20090511	
		10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Shin Splints.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral shin splint condition began in March 2003 while running.  The CI was treated conservatively and was approved to take a bicycle test for training but was unable to do so due to an elevated heart rate during testing, which was fully evaluated by cardiology each time and cleared.  A bone scan in January 2007 noted no evidence of stress fractures but noted uptake consistent with shin splints.  Magnetic resonance imaging on 22 May 2008 was positive for bilateral soft tissue swelling over the bilateral aspects of the both anterior calves, consistent with shin splints.  The CI was evaluated for exercise induced compartment syndrome and was found to have elevated lateral compartment pressures, greater on the left.  Surgical treatment with fasciotomies was discussed but the CI preferred to avoid surgery.  There was no change in her condition with additional physical therapy and the CI requested a MEB.  The MEB forwarded “bilateral shin pain” for PEB adjudication.  

The MEB NARSUM examination on 17 September 2008, 4 months prior to separation, noted complaints of bilateral lower leg pain with running or fast walking.  Physical examination showed a normal gait.  There was full range of motion (ROM) of both lower extremities, with full dorsiflexion and plantar flexion of the ankles with tenderness to pressure along the lateral aspect of the lower legs.  No swelling or redness was present.  The examiner noted “no muscle group involvement.”

At the 11 May 2009 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported intermittent lower leg pain three times per week, brought on by activity and relieved by rest and anti-inflammatory medications, and she was able to function with medication.  She reported that she could not run at all and sometimes could not walk as well.  Physical examination showed a normal gait.  Lower extremity circulation was intact, there was no swelling.  Examination of the tibia and fibula was normal bilaterally.  There was full ROM of the ankles and there was no additional limitation of motion, pain, weakness, lack of endurance, or incoordination.  There was no muscle atrophy and strength, sensation, and reflexes were normal throughout.  There was no peripheral nerve involvement noted.  The VA examiner diagnosed intermittent shin splints and noted a history of bilateral compartment syndrome with normal examination of the legs.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left shin splint conditions each 10%, both coded 5299-5262 (analogous to tibial impairment).  The VA rated the bilateral shin splints 0%, coded 5099-5024 (analogous to tenosynovitis), citing without evidence of painful motion or limited motion.  There was evidence of pain and easy fatigability of the lower extremities with use due to exercise induced compartment syndrome which supports a 10% rating coded as 5399-5312 (Group XII) IAW VARSD §4.73 (muscle injuries) an analogous code for anterior compartment syndrome, based on the intermittent presence of pain and lowered threshold of fatigue characteristic of the “moderate” level.  The intermittent nature of the CI’s symptoms without evidence of muscle atrophy or sustained muscle weakness, argued against characterizing the muscle injury as “moderately severe” for the higher rating under this code.  The Board considered alternative VASRD musculoskeletal and analogous codes, but all were less applicable and not advantageous to rating.  Therefore, although the Board arrived at 10% ratings for each of the right and left shin splint conditions with an alternate coding approach, there was no ratings benefit to the CI.  Therefore, no change is recommended to the PEB’s coding choice.  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.  

BOARD FINDINGS:  In the matter of the bilateral shin splints condition and IAW VASRD §4.71a, the Board unanimously or majority 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 20140721, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03682.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings