RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00618
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Basic Trainee, medically separated for “chronic bilateral lower extremity (LE) pains” with a disability rating of 0%.

CI CONTENTION:  “Request all conditions.”  The 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 - 20060609	VARD - 20080814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral LE Pains	5022	0%	Snapping Hip Syndrome, Right	5299-5251	NSC	STR	
			Snapping Hip Syndrome, Left	5299-5251	NSC	STR	
			Shin Splints, Right Leg	5312	NSC	STR	
			Shin Splints, Left Leg	5312	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  None	

ANALYSIS SUMMARY:

Chronic Bilateral LE Pains.  The PEB combined the bilateral chronic shin splints and bilateral snapping hip syndrome conditions as a single unfitting condition coded 5022 and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudication.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral LE pain condition began in 2005 during basic training. 

The 4 May 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain in the lower leg and hips with running.  The physical examination showed full active range of motion (ROM) of the hips, knees, and ankles.  There was bilateral tenderness at the front of the lower leg and painful hip motion with external rotation.  There was no hip snapping or popping with internal or external rotation.

During a 6 May 2006 physical therapy evaluation, physical examination revealed right hip flexion to 108 degrees (normal 125), extension to 15 degrees (normal 20), abduction to 42 degrees (normal 45), and adduction to 30 degrees (normal 45); left hip flexion to 121 degrees, extension to 15 degrees, external rotation 43 (normal 45), adduction to 29 degrees (normal 45).  All other ROMs were normal.

There was no VA Compensation and Pension examination performed for this panel to review.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral LE (tibia and hip) pain condition under a single 10% disability rating, coded 5022 (periostitis), citing “rated for motion.”   The VA denied the CI’s claim for service connection of the bilateral LE pains condition, approaching the condition by describing it as right snapping hip syndrome, coded analogous to 5251 (limitation of flexion of thigh), left snapping hip syndrome, coded analogous to 5251 (limitation of flexion of thigh), right leg shin splints, coded 5312 (Group XII function of the foot and leg) and right leg shin splints, coded 5312, (Group XII function of the foot and leg).  For all of these, the VA cited that the CI did not attend her examination and STR evidence was used.

The panel noted that bilateral shin splints and snapping hip conditions were profiled and implicated in the commander’s statement.  Panel members agreed each condition (right shin splints, left shin splints, right snapping hip, and left snapping hip) could be reasonably justified as separately unfitting.

Although there was evidence of bilateral lower leg tenderness, there was no evidence of pain- limited leg motion for a 10% rating IAW VASRD §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right and left shin splints condition, coded 5022.

There was no hip limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5251, 5252).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right and left snapping hip condition, coded 5299-5251.

BOARD FINDINGS:  In the matter of the right shin splints condition, the panel majority recommends it as separately unfitting and a disability rating of 0%, coded 5022 IAW VASRD §4.71a.  In the matter of the left shin splints condition, the panel majority recommends it as separately unfitting and a disability rating of 0%, coded 5022 IAW VASRD §4.71a.  In the matter of the right snapping hip condition, the panel majority recommends it as separately unfitting and a disability rating of 10%, coded 5299-5251 IAW VASRD §4.71a.  In the matter of the left snapping hip condition, the panel majority recommends it as separately unfitting and a disability rating of 10%, coded 5299-5251 IAW VASRD §4.71a.  The single voter for dissent recommends no change and did not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shin Splints	5022	0%	
Left Shin Splints	5022	0%	
Right Snapping Hip Syndrome	5299-5251	10%	
Left snapping Hip Syndrome	5299-5251	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006460, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure