RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00438
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Power Generator Equipment Repairer, medically separated for “low back pain” and “lower leg pains,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20051212	VARD - 20060921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radiating Low Back Pain	5299-5237	10%	Degenerative Disc Disease at L5-4 and L5-S1	5242	0%	STR	
Chronic Anterior Lower Leg Pains	5022	0%	Bilateral Shin Splints	5099-5022	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Non-Radiating Low Back Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2003 during Basic Training.  Radiographic (X-ray) studies of the lumbosacral spine in March 2004 demonstrated pedicles that appeared short.  A computerized tomography (CT) scan showed mild degenerative disk disease at L4-5 and L5-S1 and mild spinal canal stenosis with congenitally short pedicles.  
Orthopedics evaluation in September 2004 indicated the CI had back pain for about 3 years and examination revealed a limited range of motion (ROM) of flexion and extension.  There was no surgical indication, and there was no overall progression with respect to the lower back pain after physical therapy treatment.  In May 2005, physical therapy ROM measurements were approximately 75% forward flexion, 90% extension, left lateral flexion within normal limits, and 90% right lateral flexion.  Despite treatment, the back 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 “low back pain” for PEB adjudication.

The MEB NARSUM examination on 8 June 2005, 9 months prior to separation, noted complaints of chronic low back pain.  Physical examination revealed a normal gait and posture with mild tenderness to palpation.  A ROM measurements showed a normal flexion of 90 degrees and a combined ROM of 185 degrees (normal 240).  At the MEB examination in July 2005, 8 months prior to separation, the CI reported back pain.  Physical examined revealed tenderness to palpation.  

At the time of medical clinic appointment in December 2005, the CI had back pain of 1 day’s duration that began during physical training.  On examination he had tenderness on palpation of the lumbar spine with muscle spasms.  No sensory abnormalities or motor dysfunction was present.  Treatment consisted of tramadol (an opioid-like medication), diazepam (a muscle relaxer), and ice message.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5237 code (lumbosacral strain), citing tenderness.  The CI failed to report for his VA Compensation and Pension (C&P) examination in June 2006, 3 months after separation.  The VA assigned a 0% rating using the 5242 code (degenerative arthritis of the spine) based on service treatment records, citing no evidence of current symptomatology.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of tenderness.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula for IVDS, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 back condition.  

Chronic Anterior Lower Leg Pains.  According to STR and the MEB NARSUM, the CI’s lower leg pain condition began in September 2003 during Basic Training.  A bone scan in November 2003 showed bilateral grade I femoral stress fractures, bilateral grade II tibial stress fractures and stress related changes at the bilateral knees and ankles.  X-rays in February 2004 demonstrated normal tibiae and fibulae.  Examination revealed bilateral lower extremities with full ROMs, no laxity or apprehension.  There was no redness, warmth, or swelling, but there was point tenderness along the mid tibia, left greater than the right.  Treatment consisted of Motrin (ibuprofen, an NSAID) and a profile for 6 weeks.  

At the time of an acute care clinic appointment in April 2004, the CI complained of knee and leg pain after reinjuring himself during a training exercise due to lifting and carrying excessive weight and jumping.  There was tenderness to palpation over the knees and anterior tibia greatest at a tibial tuberosity every time walking or running.  Treatment consisted of piroxicam (an NSAID) and a profile for 30 days.  

At the time of a medical clinic appointment in May 2004, the CI complained of increased pain on the left tibia.  Meloxicam (an NSAID) was prescribed and a repeat bone scan revealed mild areas of increased uptake along the bilateral anterolateral tibiae consistent with shin splints and a focal area of increase uptake in the right anterior ankle consistent with stress reactive changes.  There was no surgical indication.  Despite treatment, the lower leg pain 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 “shin splints lower extremity bilateral” for PEB adjudication.

The MEB NARSUM examination on 6 June 2005, 9 months prior to separation, noted complaints of bilateral shin splints, which were stable.  Physical examination showed tenderness to palpation on the anterior mid shaft bilaterally without evidence of edema or crepitus.  At the MEB examination (recorded on DD form 2808) dated July 2005, 8 months prior to separation, physical examined revealed tenderness without evidence of edema, ecchymosis or crepitus along the shins bilaterally and a normal examination of the hips and ankles.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5022 code (periostitis), citing chronic anterior lower leg pains.  The VA also assigned a 0% rating using an analogous 5099-5022 code (periostitis) based on a noncompensable evaluation because the CI did not report for the VA C&P examination and there was no evidence of current symptomatology.  There was no significant limitation of motion of the knees to warrant a rating using codes 5260 (leg limitation of flexion) or 5261 (leg, limitation of extension).  Board members discussed whether the use of code 5262 (tibia and fibula, impairment-malunion with slight knee or ankle disability) was applicable at the time of separation.  The CI did initially have bilateral stress fractures of the tibia; however, follow-up X-rays and a bone scan did not demonstrate stress fractures, although there were findings consistent with shin splints and stress reactive changes 22 months prior to separation.  Therefore, at the time of separation, there was no evidence of a malunion of the tibias or knee or ankle disability to support a rating for either or both lower extremities.  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 for the lower legs pain condition.   

BOARD FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the lower legs pain 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 20150531, 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

08 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000103 (PD201500438)

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