RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03791
BRANCH OF SERVICE:  Army	                        SEPARATION DATE:  20081017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Initial Entry Trainee, medically separated for “periostitis, right tibia,” with a disability rating of 10%.    

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 - 20081006	VARD - 20081105  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Periostitis, Right Tibia	5022	10%	S/P Right Leg Anterior Fasciotomy, Muscle Group XII	5399-5312	10%	20080826	
			Scar, Right Leg	7805	0%	20080826	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Periostitis, Right Tibia Condition.  The record shows that in October 2007 during basic training, the CI tripped on a curb while in full combat gear which resulted in immediate pain and swelling.  His pain persisted despite the use of crutches and duty limitations.  He was referred to orthopedics on 16 October 2007 and diagnosed with compartment syndrome (a painful condition in which there is swelling in a muscle compartment bound by fascia leading to reduced blood flow with potentially severe consequences including death of the muscle).  This was treated surgically that same day.  He began rehabilitation, but then noted similar symptoms on the left which was also diagnosed with compartment syndrome and treated surgically on 21 March 2008.  He recovered from both surgical procedures, but had persistent pain.  He was subsequently diagnosed with left anterior tibial periostitis (left shin splint).  He was entered into the Medical Evaluation Board (MEB) process for chronic lower extremity pain.  A bone scan on 2 July 2008 recorded uptake in both ankles, tibial shafts (shin bone), and in the tibia near the knee, right greater than left.  This was thought to be consistent with healing stress reaction.  The narrative summary (NARSUM) was dated 8 July 2008, 3 months prior to separation, indicated the CI had ongoing right shin pain.  The examination was remarkable for tenderness over the right shin.  The sites of the prior fasciotomies were well healed.  The neurological examination was normal as was the gait.  The calf muscles were non-tender.  Slight tenderness was noted over the left shin on the DD Form 2808, Report of Medical Examination, accomplished the same day.  An X-ray of the right leg (shin) was normal on 27 July 2008.  At the VA Compensation and Pension (C&P) examination performed on 26 August 2008, 2 months before separation, the CI reported limitations in walking, standing, and lifting.  On examination, his gait and posture were normal.  The muscles had good tone and no loss of substance.  The neurological examination was normal.  The CI was assessed for residuals from the compartment syndrome, but the shin splint condition was not directly addressed.  The range of motion (ROM) of the knees was normal.  The ankle showed reduced dorsi-flexion (toes up) at 11 degrees (20 degrees normal) and plantar flexion (toes down) at 32 degrees (45 degrees).  The recorded motion was limited by the onset of pain.  No comment was found regarding tenderness of the right shin.  A note in physical therapy (PT) that day recorded that the CI was issued a new cane.  Tenderness of the shin was still present when evaluated in primary care on 29 August 2008, an addendum to the NARSUM.  An additional addendum to the NARSUM done the same day recorded that the compartment syndrome was successfully treated and the medically unacceptable condition was the periostitis of the right lower leg.  The ROM of the right knee was slightly reduced in flexion at 130 degrees (VA normal 140 degrees), but this was the same as the less affected left knee.  The ankle was normal in dorsi-flexion at 20 degrees and exceeded the VA normal value of 45 degrees at 50 degrees plantar flexion (toes down).  The Board found no explanation for the variance between the ankle ROM at the VA C&P evaluation and the PEB evaluation, 3 days later.  It noted that the normal ROM at the PEB evaluation is more consistent with the normal gait recorded by the VA C&P examiner.  Also, although speculative, it appears that the VA examiner did not push the ROM past the onset of pain.  Typically, the limit of motion exceeds the onset of pain and is reached when there is a mechanical limit or pain precludes further motion.  The final note in the record prior to separation was dated 3 October 2008, 2 weeks prior to separation, where the CI reported chronic right leg pain dating from the initial compartment syndrome and fasciotomy.  An examination was not accomplished, but the examiner recorded that the symptoms were improving with treatment.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right tibia periostitis condition at 10%, coded 5022 (periostitis).  The VA did not rate the CI for the shin splint condition, but did rate the CI at 20% for the right hip, 10% for the right ankle, and 10% for the right leg status post fasciotomy.  The Board observed that these are separate conditions and were not considered by the PEB.  They are, therefore, outside the scope of the board and not ratable.  The ROM for both the ankle and knee are non-compensable on the PEB examination.  The VA values for the ankle could support a 10% rating; however, the probative value of this set of measurements is compromised as discussed above and, regardless, provides no rating advantage to the CI.  There was no evidence in the record that the scar interfered with duty after the initial healing.  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 right tibial periostitis condition.  

BOARD FINDINGS:  In the matter of the right tibial periostitis 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 2014801, 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 XXXXXXXXXXXXXXXXXX, AR20160011776 (PD201403791)

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