RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00122
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantry Recruit, medically separated for “chronic right leg pain, status post right proximal tibial stress fracture” with a disability rating of 10%.  

CI CONTENTION:  The CI requested all conditions be considered.  His 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 - 2001216	VARD - 20050315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Leg Pain Status Post Proximal Tibial Stress Fracture 	5099-5003	10%	Chronic Right Leg Pain Status Post Proximal Tibial Stress
Fracture	5099-5262	10%	20050104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Leg Pain Status Post Proximal Tibial Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s tibial stress fracture condition began in March 2004 during basic training with no history of acute trauma.  All entries in the STR documented normal knee range of motion (ROM), and tenderness of the medial knee (at the tibial plateau).  An antalgic gait, use of crutches, and pain with single leg stance were all intermittent.  Radiographic evaluations in April and July 2004 documented proximal tibial stress reaction.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right leg pain status post right proximal tibial stress fracture” for PEB adjudication.  

At the MEB NARSUM examination performed on 28 October 2004 (3 months pre-separation), the CI reported constant pain and an inability to run, bend, and squat repetitively.  The physical examination showed an antalgic gait, tenderness of the proximal tibia, normal ROM, and no evidence of swelling.  At the MEB examination (documented on DD Form 2808) dated 6 November 2004, the physical examination showed tenderness of the proximal tibia.  

At the 4 January 2005 VA Compensation and Pension (C&P) evaluation (1 month pre-separation, the CI reported constant pain, and denied functional impairment, lost time from work, and incapacitation.  The physical examination showed a normal gait, no assistive devices, normal ROM of the knee (0-140 degrees), and no evidence of instability, laxity, or meniscal injury.  Painful motion was not addressed, however there was no additional limitation after repetition from pain, fatigue, weakness, lack of endurance, or incoordination.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the leg condition, analogously coded 5099-5003 (degenerative arthritis), citing a rating IAW the US Army Physical Disability Agency pain policy.  The VA also rated 10% for the leg condition analogously coded 5299-5262 (tibia and fibula, impairment of), based on the STR evidence and C&P examination prior to separation, citing slight knee disability following a proximal tibial fracture.  

The Board considered the evidence for a higher rating.  There was no evidence of ‘moderate’ knee or ankle disability for an analogous rating under 5262 and no evidence of ‘moderate’ impairment of the knee for a higher rating coded under 5257.  There was no evidence of flexion limited to 30 degrees or extension limited to 15 degrees for a higher rating under 5260 or 5261.  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 right tibial stress fracture condition.  

BOARD FINDINGS:  In the matter of the right tibial stress fracture condition, 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 20150129, 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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20170003003 (PD201500122)

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.

Enclosure
CF:
( ) DoD PDBR
( ) DVA