RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00793
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Combat Control Helper) medically separated for shin splints with a combined disability rating of 10%.  

CI CONTENTION:  The CI contended for his unfitting condition. 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 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 - 20070730	VARD - 20081126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Testicular/Epididymal Pain	8799-8730	0%	Left Testicular Pain	7806	NSC	20081112	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Persistent Severe Shin Splints.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s severe bilateral shin splints condition began in October 2006 during basic training.  A bone scan was consistent with shin splints and magnetic resonance imaging (MRI) demonstrated minimal, patch, pretibial periosteal edema, which was much less pronounced then would be expected on the comparison bone scan study, but was consistent with the reported history of mild shin splints and no evidence of fracture. For treatment the CI used crutches for ambulation and his activity modification consisted of no running.  At an orthopedic clinic evaluation on 16 April 2007 the CI reported his symptoms were unchanged since they began whenever he tried to participate in unit physical training.  On 8 March 2007, the CI was checked for compartment syndrome.  After running until symptomatic, his compartment pressures were within normal limits and were on the right 13 on the anterior compartment and 8 on the lateral compartment and on the left were 12 on the anterior compartment and 8 on the lateral compartment.  The posterior compartments were soft and compressible and he had tenderness over the musculature of the lower legs and had significant tenderness over the medial tibia at the junction of the middle and distal third bilaterally.  Neurovascular examination was normal and he had no paresthesias or decreased sensation.  At follow-up on 19 April 2007, the CI had no improvement with conservative treatment including physical therapy, anti-inflammatory medications, and activity modification.  On examination he had tenderness bilaterally along the anterior aspect of the tibia.  The compartments were soft and compressible and he had 5/5 strength in the muscles (tibialis anterior, EHL (extensor hallucis longus), gastroc-soleus, and peroneals) of the legs.  Sensation and pulses were intact and symmetric bilaterally.  The NARSUM examination dated 3 May 2007, 4 months prior to separation, noted the CI was able to run for just a very short distance before the pain returned.  

The CI failed to report for a VA Compensation and Pension (C&P) examination to determine the presence and severity of his claimed leg condition.  The CI had not submitted or cited any other evidence for consideration.  

The Board directed attention to its rating recommendation based on the above evidence.   The PEB assigned a 10% rating for the persistent severe shin splints under an analogous 5099-5022 code (Periostitis).  The VA also assigned a 0% rating using the 5019 code (Bursitis) based on the CI’s failure to report for a VA C&P examination.  The PEB combined the bilateral shin splints conditions as a single unfitting condition coded 5099-5022 and rated 10%.  The approach by the PEB commonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board’s initial charge in this case was 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 Board 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 Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral shin splints conditions was presented above.  In this case, a bilateral condition was alluded to in the profile, but no specific diagnosis was recorded on the profile IAW Air Force policy, and the bilateral persistent shin splints condition was implicated by the NARSUM and in the commander’s statement.  Members agreed that each leg’s shin splint condition is separately unfitting and that identical coding and ratings are applicable.  First, Board members noted that the PEB used the analogous 5022 code, which is rated IAW code 5003 (Arthritis, degenerative).  In this case there was no compensable ROM, but the CI had tenderness over the medial tibia bilaterally.  While the CI did not have involvement of the joints, he nevertheless did have imaging findings of shin splints bilaterally and pretibial periosteal edema, which is rated 10% and no higher in the absence of occasional incapacitating exacerbations.  Alternatively, Board members considered a rating option using the 5262 code (Tibia and fibula, impairment of :).  However, although there was a shin splint involvement of each leg, there was no evidence of nonunion or malunion.  However, use of an analogous code 5299-5262 was considered, but there was no reported knee or ankle disability to warrant a rating higher than 0% for each leg, which affords no benefit to the CI. 

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 persistent severe shin splints condition.   

BOARD FINDINGS:  In the matter of the persistent severe shin splints 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 20150602, w/atchs
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-2015-00793.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXXX

Attachment:
Record of Proceedings