RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00329
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20041014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E2, Infantry, Gun Crews, and Seamanship Specialist, medically separated for “bilateral ankle stress fracture” and “bilateral medial tibial plateau stress fractures,” rated 10% and 10%, respectively, with a combined  disability rating of 20%.

CI CONTENTION:  “Bilateral tibia stress fractures, bilateral ankle stress factor, migraines, severe depression from still wishing I was in the navy.”  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 - 20031017	VARD - 20041202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Ankle Stress Fracture
	5022-5003	10%	Left Lower Extremity Stress Fracture (Left Medial Tibial Plateau Stress Fracture and Left Ankle Stress Fracture	5262	10%	20031014	
Bilateral Medial Tibial Plateau Stress Fractures	5003-5262	0%	Right Lower Extremity Stress Fractures (Right Medical Tibial Plateau Stress Fracture and Right Ankle Stress Fracture)	5262	10%	20031014	
		10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Bilateral Ankle Stress Fracture.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain condition began in July 2003, 3 weeks into basic training, after he reported a complaint of left knee pain following physical training.  The pain was reported with ambulation and increased with running.  No history of trauma was reported.  Radiographic (X-ray) studies on 13 August 2003 were negative for fracture.  Bone scan on 18 August 2003 demonstrated bilateral medial tibial plateau stress fracture and bilateral ankle stress induced bony changes.  Despite Physical Therapy, medications, and activity limitations, the CI continue to complain of left knee and bilateral ankle pain, the condition could not be rehabilitated to the point of allowing for unrestricted duty.  The MEB forwarded “bilateral medial tibial plateau stress fractures” and “bilateral ankle stress fractures,” for PEB adjudication.  

The MEB NARSUM examination on 4 September 2003, 13 months prior to separation, noted complaints of inability to run greater than 1/4 mile, walk, or stand for prolonged periods of time due to left knee pain and bilateral ankle pain.  Physical examination showed bilateral ankle range of motion (ROM) normal dorsiflexion of 20 degrees and a plantar flexion of 40 degrees (normal 45).  There was tenderness to palpation of the medial malleolus (ankle) on the left.  No instability or edema was noted.  

At the 14 October 2003 VA Orthopedics Compensation and Pension (C&P) evaluation, performed 12 months before separation, the CI reported bilateral ankle pain, left greater than right with nominal walking.  Physical examination showed bilateral ankle ROM normal dorsiflexion of 20 degrees and a plantar flexion of 40 degrees.  There was no tenderness to palpation of the ankle bilaterally.  

The PEB rated the bilateral ankle stress fracture condition 10%, analogously coded 5022-5003 (arthritis, degenerative), applying a bilateral factor.  The VA took a different approach to the combined conditions, see below for discussion.  

Bilateral Medial Tibial Plateau Stress Fractures.  (See bilateral ankle stress fracture above for brief history.)  The MEB NARSUM examination on 4 September 2003, 13 months prior to separation, noted complaints of inability to run greater than ¼ mile, walk, or stand for prolonged periods of time due to left knee pain.  Physical examination showed bilateral knee ROM flexion of 130 degrees (normal 140), normal extension of 0 degrees, and tenderness to palpation at the medial tibial plateau (knee) bilaterally.  No instability or edema was noted.  

At the 14 October 2003 Orthopedics VA C&P evaluation, performed 12 months before separation, the CI reported bilateral knee pain, right more than left with nominal walking.  Physical examination showed bilateral knee ROM flexion of 130 degrees (normal 140), normal extension of 0 degrees.  There was tenderness to palpation at the medial right tibial plateau.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral medial tibial stress fractures condition 10%, analogously coded 5003-5262 (tibia and fibula, impairment of), again, using a bilateral factor.  The VA rated the right lower extremity stress fractures (right medial tibial plateau stress fracture and right ankle stress fracture) condition 10% coded 5262 (tibia and fibula, impairment of), based on the VA C&P examination 12 months before separation, citing lack of endurance of the right knee and ankle  The VA also rated the left lower extremity stress fractures (left medial tibial plateau stress fracture and left ankle stress fracture) condition 10% coded 5262 (tibia and fibula, impairment of), again citing lack of endurance of the left knee and ankle  The CI complained of right knee pain in the third week of basic training.  After appropriate treatment with pain medications, physical therapy and light duty, he underwent a bone scan that showed stress changes/stress fractures in multiple areas of the bilateral tibia and/or fibula (lower leg between the ankle and knee).  There was no evidence of malunion of the tibia or fibula with moderate or marked knee or ankle disability allowing for a higher 20% rating using code 5262.  There were no ratable limitation of ROM of either knee or ankle, nor painful motion justifying use of code 5003.  

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 bilateral ankle stress fracture and bilateral medial tibial plateau stress fracture conditions.  

BOARD FINDINGS:  In the matter of the bilateral ankle stress fracture and bilateral medial tibial plateau stress fractures conditions, 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 20150527, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 14 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)