RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04218
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20030630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “right lower extremity [RLE] pain with stress fracture,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s rating did “not reflect conditions at discharge.”  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 - 20030612	VARD - 20030702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
RLE Pain…	5022	0%	S/P Stress Fracture, Right Tibia	5299-5262	10%	STR	
COMBINED RATING:  0%	COBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Lower Extremity Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right lower extremity pain condition began in late January 2003 after running.  A bone scan showed stress related changes just above the ankle in the tibia (shin bone).  He was treated conservatively with duty restrictions, medications, and physical therapy (PT).  He was noted to have full range of motion (ROM) at a PT appointment on 28 March 2003, 3 months prior to separation.  He was not able to begin basic training and an MEB was initiated.  The MEB forwarded a RLE stress fracture for PEB adjudication.  The MEB NARSUM examination was accomplished by an orthopedic physician’s assistant on 30 March 2003, 2 months prior to separation.  It noted complaints of right knee and ankle pain with pain beginning after running 25 yards.  On examination, he was noted to have a normal gait and full active ROM.  The tibia was tender to palpation.  The examination of the knee and ankle was otherwise unremarkable.  A VA Compensation and Pension (C&P) evaluation was not performed proximate to separation.  X-rays of the knee and ankle on 11 September 2003 were normal other than a moderate effusion (fluid) above the knee cap.  A post-separation examination in PT dated 7 October 2003, 3 months after separation, recorded the CI had not gotten better over the prior few months (since separation).  On examination, mild muscle atrophy was noted as was laxity of the medial collateral ligament (no history of injury was found to account for this).  The ROM for the ankle and knee was slightly reduced, but the gait was normal.  The Board noted that a post-separation C&P examination remote from separation on 15 March 2005 did not record instability or atrophy.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the RLE pain with stress fracture diagnosis at 0%, coded 5022 (periostitis).  The VA rated status post (S/P) stress fracture condition at 10% coded 5299-5262 (malunion with impairment of the tibia and fibula), relying on the STR and citing the tenderness present on examination, for a slight disability.  The Board observed that the CI had a normal gait and ROM proximate to separation.  Bony abnormalities were not seen on X-ray.  The PT examination was an outlier from other examinations before and after separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the RLE pain with stress fracture condition.  

BOARD FINDINGS:  In the matter of the RLE pain with stress fracture 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 20140521, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013848 (PD201404218)

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