RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00731
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20061023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Functional Support and Administration, medically separated for “[right] tibial stress fracture,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20060901	VARD - 20070427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Right] Tibial Stress Fracture	5003-5262	10%	Right Tibial Stress Fracture	5262	0%	20061209	
			Scarring secondary to cast removal from Right Tibial Fracture	7805	NSC	20061209	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Tibial Stress Fracture Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right leg condition began in May 2006 while the CI was completing her final boot camp physical fitness test.  The CI was successfully treated with casting and activity restrictions for a right tibial shaft stress fracture.  Radiographic study (right tibia and fibula) revealed mature callous formation and evidence of gap healing bone, tibial shaft fracture.  Despite treatment and ongoing healing, the right leg condition could not be adequately rehabilitated within the timelines required to return to training and the CI was referred for MEB.  The MEB forwarded “stress fracture of tibia or fibula” for PEB adjudication.

The MEB NARSUM examination in July 2006, approximately 3 months prior to separation, noted the CI was continuing to heal from her right tibial stress fracture and she was in a cast boot.  X-ray dated 24 July 2006 showed a healing nondisplaced fracture of the right distal tibia.  Physical examination showed the CI ambulating with crutches and in a cast boot.  There was no tenderness at the tibial fracture site and the right leg was neurovascularly intact.  There was full ankle and knee range of motion (ROM).  The orthopedic surgeon indicated that there appeared to be clinical and radiographic union (healing) and the CI was started on weight-bearing as tolerated.

At the 9 December 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported having pain in her right tibial region increased with standing or walking for prolonged periods.  She indicated two areas from scaring due to cuts during cast removal.  X-ray showed cortical irregularity of the distal shaft of the right tibia likely related to old healed fracture.  Physical examination showed a normal gait.  There was tenderness over the area of the prior tibial fracture.  There was normal ROM of the knee and ankle without painful motion.  There was normal lower extremity strength and sensation.  There were two thin scars (3/4 inch and 1 inch long) which were non-tender and without symptoms.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right tibial stress fracture condition 10%, analogously coded 5003-5262 (arthritis, degenerative - tibia and fibula, impairment).  The VA rated the right tibial stress fracture condition 0%, coded 5262 (tibia and fibula, impairment) based on the VA C&P examination 2 months after separation, citing a noncompensable evaluation was assigned in the absence of malunion of the tibia and fibula with slight knee or ankle disability.  The VA did not service-connect the scar condition, with a later correction for a “clear and unmistakable error,” which assigned a 0% rating, coded 7804 (scar, unstable or painful) citing “non-painful stable, linear scars.”

Board members agreed the right tibial stress fracture was healing well at the pre-separation MEB NARSUM examination and the proximate post-separation VA examination showed continued healing and improvement.  There was no examination proximate to separation that indicated there was greater than slight knee or ankle disability to support a 20% or higher rating.  There was no alternative coding that would warrant any rating higher than the 10% awarded by the PEB.  There was no evidence that the scars rose to the level of unfitting based on the preponderance of the evidence at separation.  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 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 20150603, w/atchs
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 13 Dec 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:

		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 

						  XXXXXXXXXXXXXXXXXX	     				  			 		 Assistant General Counsel
						  (Manpower & Reserve Affairs)