RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03881
BRANCH OF SERVICE:  Army	BOARD DATE:  20150120
SEPARATION DATE:  20070925

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Health Care Specialist) medically separated for bilateral shin splints.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) although he was authorized to perform alternate physical fitness testing.  He was issued a permanent L1/U2 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral medial tibial stress syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “bilateral medial tibial stress syndrome” as unfitting, rated 10% with application of the VA 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 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 20070725	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Medial Tibial Stress Syndrome	5099-5022	10%	No VA Disability Claim Filed	
Other x 0 (Not In Scope)		
RATING:  10%	RATING:  None	

ANALYSIS SUMMARY:

Bilateral Medial Tibial Stress Syndrome.  The CI developed bilateral medial lower leg pain, aggravated with running in mid-2006 (no history of direct trauma).  Subsequent X-rays and bone scan were normal.  With progressive painful symptoms, orthopedics specifically identified bilateral shin splints with associated overuse tendonitis.  Despite treatment to include medication, altered activities, and physical therapy, his painful symptoms remained with increased activity and or prolonged standing.  His conservative treatment continued and he was referred to an MEB.  His limitations included no running or road marching and the commander’s statement corroborated such limitations.  At his MEB narrative summary (NARSUM) (performed 3 months prior to separation); he reported the correlation of bilateral leg symptoms with aggressive activity.  His physical examination was detailed and revealed bilateral tibia tenderness with corresponding edema.  The knees had normal range-of-motion (ROM) without instability.  The examiner diagnosed bilateral medial tibial stress syndrome and listed the condition as “stable.”  There was no VA Compensation & Pension filing that was accomplished at the time of this Board’s review; and, therefore any impairment rating recommendation will be based upon the MEB exam and terminal encounter documents within the service treatment record (STR).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB chose to bundle the lower extremities and assign an analogous rating of 10% with 5022 code (periostitis) which defaults to the 5003 code (arthritis, degenerative) based on residual tenderness without loss of joint motion.  The Board first considered whether each leg condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  The objective clinical STR evidence remained equivocal to both lower extremities without indication of one leg more impaired than the other.  The preponderance of clinical evidence throughout the documented exams overwhelmingly described adverse findings as “bilateral” with rare identification of right or left involvement.  Board members agreed that the clinical evidence as presented in this case would involve a high degree of speculation to conclude that the disability either separately confined to one leg or a combination of both legs (PEB’s rating) would have rendered the CI incapable of performing his military duties and therefore, making him unfit for continued military service.  Board members agreed to invoke VASRD §4.3 (reasonable doubt) and concede in favor of the CI that the frequent equivalent bilateral findings in this case rose to the level that each leg, as an isolated condition, would have rendered the CI incapable of continued service within his MOS; and, accordingly recommends separate ratings for the right and left legs.

Although the NARSUM indicated normal ROM about the lower extremities without comment in reference to painful motion, Board members considered a rating of the tibial condition conceding VASRD §4.40 (functional loss) noting (“a part which becomes painful on use must be regarded as seriously disabled”), based upon the CI’s reported complaints of painful symptoms upon running or increased activity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the Board recommends separate right and left disability ratings of 10% each for the bilateral leg 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 bilateral medial tibial stress condition and IAW VASRD §4.71a, the Board unanimously recommends separate disability ratings of 10% each leg, coded 5099-5022.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation.

CONDITION	VASRD CODE	RATING	
Medial Tibial Stress Syndrome; Right Leg	5099-5022	10%	
Medial Tibial Stress Syndrome; Left Leg	5099-5022	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140814, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150011215 (PD201403881)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA