RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00964
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “left leg pain status post therapy of open left tibial fracture, with 7 degrees varus deformity distal tibia,” with a disability rating of 0%.

CI CONTENTION:  “I believe all medical issues was not evaluated at the time of my medical board”.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060202	VARD - 20060329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Leg Pain, Open Left Tibial Fracture	5099-5003	0%	Traumatic Scar, Posterior Left Lower Extremity (LLE)	7801	10%	20051206	
			Loss of Motion, Left Knee	5260	0%	20051206	
			Loss of Motion, Left Ankle Associated with Fracture Distal Tibia, LLE, with Leg Length Discrepancy	5275-5271	0%	20051206	
			Fracture, Distal Tibia, LLE with Leg Discrepancy	5275	0%	20051206	
			Traumatic Scars, LLE	7805	0%	20051206	
			Graft Scars, Anterior Left Thigh	7805	0%	20051206	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg pain followed an improvised explosive device (IED) blast in October 2004.  He had a left tibia fracture that required multiple debridement and irrigation procedures, surgical fixation and skin grafting.  The leg infection was managed with antibiotic and a bone graft was performed in December 2004.  Despite treatment, his condition did not improve sufficiently enough to allow unrestricted duty in his MOS, therefore, he was referred to the MEB.

The MEB NARSUM examination on 6 December 2005, 3 months prior to separation, noted complaints of persistent pain and leg and ankle stiffness that increased with activity such as prolonged standing greater than 1 hour and prolonged walking greater than 1 mile.  He was not able to run or march or perform his duty as a truck driver.  Physical examination, focused on the left lower extremity, showed no evidence of inflammation and there was no bony tenderness present.  The knee was stable to stress, and range of motion (ROM) was recorded at 135 degrees (140 normal).  Ankle dorsiflexion was normal and plantar flexion was 30 degrees (70 normal).  There was no evidence of neurovascular compromise.  Mild varus deformity was noted in the distal tibia.

At the 6 December 2005 VA Compensation and Pension (C&P) examination, 3 months prior to separation, the CI reported symptoms of numbness, stiffness, and deformity after surgery.  His symptoms were precipitated by walking and cold weather and relieved by massage.  He was not taking any medication for this problem.  Physical examination noted all joints had full ROM, and muscle strength was normal in all extremities.  Evidence of inflammation was absent.  It was noted that the CI’s left lower leg was mildly shorter than the right leg.  The ankle examination was normal.  The CI could heel and toe walk.

The Panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg pain 0%, analogously coded 5003 (arthritis), citing use of the Army Physical Disability/Guidance Memorandum #13.  Likewise, the VA granted a 0% rating for the left lower extremity under multiple coding schemes corresponding to several lower extremity conditions (5260-knee LOM, 5271-ankle LOM, 5275-shortening of the lower extremity, and 7805-traumatic scars left lower extremity and anterior left thigh graft scars).  A 10% disability for traumatic scar, posterior left lower extremity, was granted.

There was no limitation of motion supporting a higher rating under the diagnostic codes for limitation of flexion or extension of thigh or leg (5251, 5252, 5253, 5260, or 5261).  However, the CI had radiographic and clinical evidence of tibia deformity (which may progress to arthritis of the knee) that resulted in numbness and stiffness, affecting his ability to run or march, or perform his job as truck driver, justifying a 10% rating IAW § 4.40 (functional loss).  The panel reviewed the post–operative report that the CI had sustained extensive soft tissue loss and bone loss secondary to the blast injury, but that the underlying muscle and soft tissue were noted to be viable.  The VA examination conducted 12 months after separation noted that the CI had sustained muscle loss to muscle of the lower extremity that had caused decreased strength and movement of the left lower leg, consistent with moderate level of disability in muscle group 11 and 12.  He had decreased strength with flexion and extension to the foot and toes with strength decreased to “about 50% compared to the opposite side.”  After deliberating, panel members agreed, the CI’s condition was better accounted for under the 5311 and 5312 codes.  The higher rating of 20% under codes 5311-5312 is met when there is evidence of moderate muscle disability due to lowered threshold of fatigue after average use, and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power, secondary to short track of missile through muscle tissue.  All panel members agreed, a rating of 20% but no higher was justified.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left leg condition, coded 5311-5312, IAW VASRD 4.57.

BOARD FINDINGS:  In the matter of the left leg pain condition, the panel recommends a disability rating of 20%, coded 5311-5312 IAW VASRD§ 4.57.  There were 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	
Left Leg Pain	5311-5312/5099-5003	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007301, XXXXXXXXXXXXXXXXXXXXX

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