RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00659
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060417

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Airman, medically separated for “bilateral tibia stress fractures,” rated 10% right and 0% left, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20060322	VARD - 20070411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Right] Tibia Stress Fracture Associated with Ankle Stress Reaction	5262	10%	Right Shin Splint	5399-5311	0%	STR	
[Left] Tibia Stress Fracture	5262	0%	Left Shin Splint	5399-5311	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Tibia Stress Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower extremity conditions began in June 2005 he suffered a mildly displaced fracture through the proximal left tibial diaphysis (proximal tibia) after he heard a pop while running a fitness test.  Treatment consisted hospitalization 24-27 June 2005 for bedrest and observation and treatment of a long leg cast with crutches and convalescent leave.  Radiographic (X-rays) studies on 16 August 2005 showed healing, but there was a stress fracture, which progressed to a “complete horizontally oriented fracture,” which was not united.  Orthopedic evaluation noted the fracture was non-displaced and the CI was placed in a CAM (controlled ankle motion) walker and referred for physical therapy.  By October 2005 the CI reported no pain and X-rays revealed interval healing.  After 2 weeks in the Get-Fit program the CI complained “pain feels like it did before.”  

At a physical therapy evaluation on 16 November 2005, the CI had tenderness to palpation in both tibia, left greater than right.  Two weeks later the CI reported that bicycling caused right shin pain and right knee popping.  A bone scan dated 8 December 2005 showed increased uptake in the left mid tibia in the region of the known healing tibia fracture and there were bilateral shin splints with a likely borderline stress fracture within the right mid tibia and severe stress changes versus a borderline stress fracture in the left tibia. There were also stress changes of the feet, ankles, and knees.  

At the time of an orthopedic clinic appointment on examination on 14 December 2005, the CI had full range of motion (ROM) of both knees and ankles, tenderness to palpation in the medial anterior tibia bilaterally, good strength, no swelling, and no sensory or motor deficits.  The CI complained of left greater than right lower extremity pain with prolonged walking and standing.  Despite treatment, the bilateral tibia stress fractures condition could not be adequately rehabilitated to meet the physical requirements of training and the CI was referred for an MEB.  The MEB forwarded “bilateral tibia stress fractures” for PEB adjudication.

The MEB NARSUM examination on 14 February 2006, 2 months prior to separation, noted complaints that despite lengthy rehabilitation efforts, any fast walking or brief running caused severe pain.  Physical examination revealed a full ROM of the knees and ankles bilaterally with tenderness to palpation over the shins without edema.  There were no sensory or motor deficits at the medial anterior tibias.  Strength was good and the CI was neurovascular intact.  

There was no VA Compensation and Pension (C&P) examination in evidence proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the right leg stress fracture, coded 5262 (impairment of tibia and fibula), citing right associated with ankle stress reaction, and a 0% rating for the left leg stress fracture condition, coded 5262.  The VA assigned a 0% rating using an analogous 5399-5311 (analogous to a muscle group XI injury) for the right lower extremity based on the STR, citing “slight muscle disability” and a 0% rating also coded 5399-5311 for the left lower extremity condition, citing “slight muscle disability.”  

Board members noted the disparity of the PEB’s rating between the right leg and the left leg since it only addressed “ankle stress reaction” for the right lower extremity.  However, the bone scan dated 8 December 2005 indicated “stress changes of the feet, ankles, and knees.”  Therefore, since “knees” refers to both the right knee and the left knee, a 10% rating for the left lower extremity is not unreasonable.  Furthermore, despite a normal ROM for both the ankles and knees, the bone scan also noted stress changes of both the right and left ankles, thereby providing additional support for a 10% rating for both the left and right lower extremities.  There was no route for a higher rating for either extremity in the absence of moderate knee or ankle disability, non-compensable ROMs with occasional incapacitating episodes, or any of the muscle codes related to hip function.  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 tibia stress fracture condition, coded 5262 and a disability rating of 10% for the left tibia stress fracture condition, coded 5262.

BOARD FINDINGS:  In the matter of the right tibia stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5262 IAW VASRD §4.71a.  In the matter of the left tibia stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5262 IAW VASRD §4.71a.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Tibia Stress Fracture	5262	10%	
Left Tibia Stress Fracture	5262	10%	
COMBINED w / BILATERAL FACTOR	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00659.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR