RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03983
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Finance, medically separated for ““bilateral lower leg pain” with a rating of 0%.

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 - 20070129	VARD - 20070820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Leg Pain	5099-5022	0%	Residuals of Stress Fracture, Right Tibia, to Include R Knee Pain	5299-5262	10%	20070612	
			Residuals of Stress Fracture, Left Tibia, to Include L Knee Pain	5299-5262	10%	20070612	
Left Knee Pain	Not Unfitting					
Depressive Disorder	Not Unfitting	Major Depressive Disorder and Anxiety Disorder	9434	30%	20070515	
Low Back Pain	Not Unfitting	DDD of the Lumbar Spine to Include Bilateral Hip Pain	5242	40%	20070612	
Bilateral Ankle Pain	Not Unfitting	Residuals of Stress Fracture, L Ankle	5299-5271	10%	20070612	
		Residuals of Stress Fracture, R Ankle	5299-5271	10%	20070612	
Shoulder Pain	Not Unfitting	Chronic R/L Shoulder Pain	5299-5201	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:

Bilateral Lower Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral lower leg pain condition began during basic training in September to October 2005 after multiple ankle sprains and a fall.  A bone scan in May 2006 revealed stress fractures in the bilateral mid-tibial shafts as well as stress changes in the knees, ankles and feet.  X-rays in June and October 2006 were reported as normal.  Follow-up bone scan in October 2006 reported ongoing healing (improvement) of stress fractures and stress changes.  There was no surgical indication.  Despite treatment, the bilateral lower leg pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “bilateral tibial stress fractures” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 18 December 2006, 3 months prior to separation, the CI reported bilateral knee and leg pain.  Physical examination showed left knee tenderness with retropatellar grind and positive patellar apprehension test.  The right knee exam was “benign.”  There was bilateral tibial tenderness with a soft tissue deformity on the left “probably due to muscle atrophy.”  The right ankle was tender with rotation and stress testing.  There was no laxity or instability of the knees or ankles.  Strength and sensation were normal.

The MEB NARSUM examination on 3 January 2007, 2 months prior to separation, noted complaints of constant 5/10 bilateral leg pain increasing to 9/10 with standing, walking, climbing stairs, lifting or carrying weight, and with impact activities.  Physical examination referenced the above 18 December 2006 examination and physical therapy examination from 27 November 2006 which showed normal bilateral lower extremity range of motion and normal strength.  The examiner stated that the CI was “significantly limited on any prolonged weight bearing.”

At the 12 June 2007 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported bilateral knee pain down to the ankle/foot and right knee grinding with pain of 4/10.  Left leg pain went from 6-7/10 to 10/10 with weight bearing for 30 minutes.  She had bilateral ankle pain “from time to time” with weight bearing, and bilateral foot pain with paresthesias (abnormal sensations) not relieved with inserts.  Physical examination showed the CI “complained of generalized pain throughout the almost 3 hour visit” and was slow, guarded, protective with all movement.  The examiner indicated that “muscle and joint examination is extremely limited.”  The CI complained of pain with any palpation of any joint and each lower leg.  There was no edema or discoloration of either shin and no obvious warmth, deformity, or swelling of any joint.  Motor, sensory and reflex testing was normal.  The examiner indicated there was “minimal effort to complete requested movements for examination.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right lower leg pain conditions bundled at 0% coded 5022 (periostitis).  The VA rated each lower leg condition 10% analogously coded 5299-5262 (tibia and fibula, impairment), based on the VA C&P examination 3 months after separation.  The VA also rated each ankle stress fracture at 10% coded 5299-5271 (ankle, limited motion) and each foot stress fracture at 10% coded 5284 (other foot injuries).

The Board agreed that the impairment from the left and right lower leg pain conditions was not separable, and that each leg was reasonably justified as separately unfitting and ratable.  Given the continued abnormal bone scan, bilateral shin tenderness and functional loss noted at the MEB NARSUM, the Board adjudged that the CI’s bilateral lower leg pain warranted a 10% rating for each leg for “slight knee or ankle disability” (10%) coded 5299-5262 (tibia and fibula, impairment).  There was insufficient indication that the impairment was moderate, or that the ankles or feet were reasonably justified as separately unfitting.  After due deliberation, and considering all of the evidence, the Board recommends a disability rating of 10% for the right lower leg pain condition and 10% for the left lower leg pain condition, each coded 5299-5262.

Contended PEB Conditions:  Depressive Disorder, Low Back Pain, Bilateral Ankle Pain, Left Knee Pain, and Shoulder Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, 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 bilateral lower leg pain condition, the Board unanimously recommends a disability rating of 10% for the right lower leg pain condition coded 5299-5262; and 10% for the left lower leg pain condition coded 5299-5262; both IAW VASRD §4.71a.  In the matter of the contended depressive disorder, low back pain, bilateral ankle pain, left knee pain, and shoulder pain 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Lower Leg Pain	5299-5262	10%	
Left Lower Leg Pain	5299-5262	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140606, 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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXXXXXXX, AR20160017744 (PD201403983)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA