RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Operations Specialist, medically separated for “left tibial stress fracture…,” 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 on 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 - 20040707	VARD - 20041119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Tibial Stress Fracture	5099-5022	10%	Recurrent Left Tibia Fractures	5262	0%	20040810	
Heterotopic Ossification of the Tibial-Fibular Interosseous Membrane	Not Unfitting	Tibias-Fibula Interosseous Membrane Ossification	5299-5262	0%		
Pes Planus		Bilateral Pes Planus	5276	10%		
Pseudofolliculitis Barbae		Pseudofolliculitis Barbae	7899-7806	0%		
Lipomas		Lipomas	7819	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Tibial Stress Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg pain/stress fracture condition began in March 1998 during advanced training.  Diagnostic imaging reported a left tibial stress fracture.  The condition flared up in November 1999, and imaging showed heterotopic ossification of the tibial-fibular interosseous membrane without evidence of an acute stress fracture.  The CI had an acute problem with a painful pop in his left leg in September 2003 and underwent compartment release (fasciotomy surgery) in December 2003.  Despite treatment, the left lower leg condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left lower extremity:  chronic pain due to recurrent tibial stress fractures” for PEB adjudication.  

At the MEB examination and orthopedic consultation dated April 2004, 4 months prior to separation, the CI reported constant pain in the left lower extremity aggravated by any weight-bearing activities.  He could walk at his own pace and distance up to 10 minutes, but had increased symptoms with any running and jumping.  Physical examination showed tenderness to pressure over the left tibia and tenderness in the soft tissue in the distal part of the anterior compartment (of the left lower leg).  There was no visible deformity or palpable mass.  The surgical incision was well healed.  Strength and reflexes were normal and there were no neurologic deficits.  The CI had left lower leg pain walking on his heels.  Diagnostic imaging in November and December 2003 showed calcification of the interosseous membrane and abnormal uptake at the tibia consistent with a grade 1 stress fracture.  

At the VA Compensation and Pension (C&P) examination in August 2004, performed 3 months after separation, the CI reported pain off and on since 1998, with difficulty running or walking over 1/4 mile.  Physical examination showed a normal gait.  Muscle strength and tone and reflexes were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5022 (periostitis) code, citing residual pain, moderate/frequent, with likely application of the US Army Physical Disability Agency pain policy.  The VA assigned a 0% rating using the 5262 (tibia and fibula, impairment) code based on the VA C&P examination 3 months after separation, citing the absence of malunion of the tibia and fibula with slight knee or ankle disability.  The MEB examination noted pain with heel walking, without noting any other knee or ankle disability.  Even considering the possible contributions from the tibia-fibula interosseous membrane ossification to the disability level of the left lower extremity, no examinations proximate to separation supported an ankle or knee disability above the slight level.  Therefore, no rating higher than the 10% awarded by the PEB was supported, regardless of 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 left tibial stress fracture condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that heterotopic ossification of the tibial-fibular interosseous membrane, pes planus, pseudofolliculitis barbae, and lipomas were 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.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  Any contribution of the heterotopic ossification of the tibial-fibular interosseous membrane condition to the disability of the unfitting left tibial stress fracture and chronic leg pain was considered in the rating above.  After due deliberation, and 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left tibial stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended heterotopic ossification of the tibial-fibular interosseous membrane, pes planus, pseudofolliculitis barbae, and lipomas conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140909, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160011778 (PD201403956)

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