RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03910
BRANCH OF SERVICE:  Army	BOARD DATE:  20150610
SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Administrative Specialist) medically separated for a bilateral shin splint condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic bilateral shin splint condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral (B/L) lower leg pain,” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, which affirmed the PEB finding and rating, and was medically separated.

CI CONTENTION:  The applicant makes no specific contention in his application.  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 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:

FPEB – Dated 20050113	VA* - (~1 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic B/L Lower Leg Pain	5022	0%	Mild Chronic Pretibial Fasciitis, Left Leg	5022	0%	20050524	
			Mild Chronic Pretibial Fasciitis, Right Leg	5022	0%	20050524	
Other x 0 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20050829 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic B/L Lower Leg Pain Condition.  The narrative summary (NARSUM) on 21 September 2004 noted the CI during Advanced Individual Training presented initially for lower leg pain that was diagnosed as shin splints (bilateral) in October 2002.  There was no documented history of trauma. The CI began to report left leg pain worse than right.  Radiographs demonstrated possible stress fracture and recommended bone scan.  On 31 January 2003, bone scan demonstrated right shin splint and left Grade 1 stress fracture.  Her condition was treated conservatively with non-steroidal anti-inflammatory medication, ice, and physical therapy.  Notes in the service treatment record also documented bilateral moderate-severe pes planus which was addressed with orthotics.  Running aggravated her pain and resting relieved it.  A repeat bone scan in July 2003 demonstrated left tibia healing stress fracture.  A third bone scan in April 2004 showed no evidence of shin splints or stress fractures.  Orthopedic consultation dated 7 May 2004 recorded the diagnosis of bilateral shin pain, right greater than left, without evidence of swelling or deformity.  Despite treatment, the CI continued to report pain in both lower extremities, aggravated by running.

At the NARSUM, the CI noted persistent lower extremity pain in both legs with left worse than right.  The examiner noted the CI had failed the Army Physical Fitness Test three times in 2003 and in January 2004, but had recently passed PT tests with limitations of no running, no moving with fighting load for at least two miles, and no 3-5 second rushes.  Range-of-motion (ROM) testing of right and left lower extremity demonstrated normal values for dorsiflexion (20) and plantar flexion (45).  The examiner diagnosed chronic shin splints.  Her profile allowed unlimited walking, biking, and swimming, but did not allow running.  The commander’s statement documented that the CI was physically capable of “reasonably” performing her duties as administrative personnel and that her condition did not prevent her from meeting the requirements of her MOS.  The commander’s statement recommended that the CI be found fit for reasonable performances of her duties as administrative personnel.  The VA Compensation and Pension (C&P) examination, approximately 6 weeks after separation, documented the report of pain after prolonged sitting, standing, or walking, without swelling.  The CI ambulates without an assistive device.  Physical examination recorded good heel and toe rising, full squatting capability, both completed without pain.  There was tenderness in both legs, left greater than right, and there was no decrease in ROM on repeated motion, and no pain on motion.  ROM documented 20 degrees of dorsiflexion (NL=20), and 40 degrees of plantar flexion (45), bilaterally.  The diagnosis of mild chronic pretibial fasciitis was recorded.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral condition as a single unfitting condition at 0%, coded 5022 (periostitis).  The VA separated the condition and rated each at 0% coded 5022.  Conditions rated under this code, are rated on limitation of motion of affected parts.  Therefore, a compensable rating under the 5022 code requires objective evidence of painful or limited motion of a major joint or group of minor joints.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, the coding scheme for 5022, allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 the Board must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each “unbundled” condition can be reasonably justified as separately unfitting in order to remain eligible for rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  Notes in the record in evidence frequently documented left leg pain worse than right.

The commander’s statement, 8 months prior to separation stated the CI was physically capable of performing her duties, and noted that her condition of “chronic stress fracture” had not required constant monitoring.  There was no indication that one leg was worse than the other.  Her profile restricted running but did not specify if her condition of shin splints related to one or both extremities.  The Board then proceeded to the rating of the left lower extremity.  Bone scans in 2003 demonstrated left leg stress fracture, findings in 2004 scan showed no evidence of shin splints or stress fracture for either leg.  The record demonstrated that the CI reported she had pain with running and had a profile that restricted running of any kind.  The record documented no episodes of swelling, giving way, of loss of function.  Left extremity ROM recordings were normal at the NARSUM and slightly reduced at the C&P examination.  Pain on motion was not documented in either examination.  The Board agreed that the record sufficiently documented pain; however, preponderance of evidence did not support a compensable rating under code 5022, or under any ROM code.  The Board unanimously agreed the left extremity condition did not rise to a level of compensability under §4.59 or §4.40.  The Board was unable to find any additional codes for consideration.  The Board then next considered the right extremity and concluded although there was documented shin pain, there was no decrease in ROM, painful motion or swelling, and no radiographic evidence of right leg pathology.  The right extremity was not compensable under the 5022 code or any of the ROM codes, and the condition did not meet the requirement for compensation under §4.59 or §4.40.  Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% for the right leg pain condition and 0% for the left leg pain condition.  As this result in no rating benefit to the CI, the Board recommends no recharacterization of the PEB adjudication for the bilateral lower leg pain 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 bilateral lower leg pain 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 20143910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160003077  (PD201403910)

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 ( ) OVA