RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04316
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Infantry, medically separated for “chronic pain, right lower extremity, status-post distal tibial contusion,” with a disability rating of 0%.  

CI CONTENTION:  “The rating of 10% that I received was for only one condition of ankle injury, the fractures that led to RSD/nerve damage the connective tissue damage was not considered, also the continuing damage has also not considered I have chronic factors in both of my leg only one was considers and I only receive a VA Disability Rating with a DoD rating of 0%.” 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 - 20030224	VARD - 20030224  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Lower Extremity	5099-5003	0%	Right Ankle Strain, Status Post Distal Tibia Contusion	5099-5020	10%	20021010	
Left Tibia Stress Fracture, resolved	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Lower Extremity.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed right lower leg pain while in Basic Training in February 2002.  After successful conservative treatment, the CI re-injured his right leg after a fall while on detail.  A bone scan revealed bilateral “shin splints” of the lower legs.  Despite treatment, the ankle 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 “right distal tibia contusion with chronic residual right lower extremity pain” for PEB adjudication.  

During the MEB NARSUM performed in September 2002, 6 months before separation, the CI’s chief complaint was unresolved bilateral lower extremity pain.  In regards to the right lower extremity, the MEB physical examination (PE) provider simply mentioned the observance of a normal gait.  The remainder of the MEB PE was devoted to the CI’s left lower extremity.  At the 10 October 2002 VA Compensation and Pension (C&P) examination, performed 5 months prior to separation, the CI’s PE revealed mild tenderness about the right tibia.  His gait was abnormal and described as a limp without directional component.  On follow-up orthopedic examination approximately 3 months prior to separation, the CI demonstrated tenderness over the distal right tibia without swelling or bruising.  His distal lower extremity neuro-vascular status was intact. 

The Board directed its attention to its rating recommendation based on the above evidence.  Utilizing the USAPDA pain policy AR 635-40, the PEB assigned a 0% rating under the analogous code of 5003 (degenerative arthritis) for the right lower extremity condition.  The VA rated the same extremity at 10% utilizing the primary code of 5020 (synovitis) citing limitation of motion.  The Board members first deliberated and agreed that given the early diagnosis of shin splints coupled with the persistence of right tibial tenderness is best represented under VASRD code 5022 (periostitis) at a 10% impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right lower extremity condition. 

Contended PEB Condition:  Left Tibial Stress Fracture.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the left tibial stress fracture was profiled, it was not implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  The MEB PE clearly indicated “no pain over the left lower extremity,” and “the CI was not tender to palpation over his left tibia,” and had a normal gait.  The provider’s final diagnosis included, “left tibial stress fracture, resolved.”   

All Board members deliberated and agreed that the primary condition that rendered the CI incapable to satisfactorily perform his military duties was the painful and bruised condition of his right lower extremity as discussed above.  Board members agreed that there was no performance based evidence from the record that the left tibial stress fracture condition (in and of itself) separately and significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the left tibial stress fracture condition and so no additional disability rating is recommended.  

BOARD FINDINGS.  In the matter of the chronic pain, right lower extremity condition, the Board unanimously recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  In the matter of the contended left tibial stress fracture condition, the Board unanimously recommends no change from the PEB’s determination 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pain, Right Lower Extremity	5022	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141121, w/attachments
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20170001290 (PD201404316)

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 10% 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