RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00993
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Network Switching Systems Operator/Maintainer, medically separated for “chronic pain, due to tibial stress fractures,” with a disability rating of 10%.

CI CONTENTION:  “Issue still prevalent.”  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 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 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 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 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 - 20041018	VARD – NO VA CLAIM 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, due to Tibial Stress Fractures	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 	

ANALYSIS SUMMARY:  

Chronic Pain, due to Tibial Stress Fractures.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic pain, due to tibial stress fractures condition began in April 2003 during Basic Training.  A bone scan in May 2003 showed a “large severe” stress fracture of the proximal right medial tibia.  A repeat bone scan in September 2003 showed no significant healing of the stress fracture.  A bone density study was normal.  The CI was evaluated by endocrinology for a metabolic cause of the non-healing fracture.  Some laboratory studies were abnormal and consistent at times with primary hyperparathyroidism.  However, repeat studies would be normal.  Due to the variability in the results the endocrinologist recommended no further testing at the time due to the stress fracture, but recommended follow-up in six months.  The MEB forwarded “slight/chronic right leg pain due to stress fractures of the tibia.”  The MEB NARSUM examination on 18 August 2004, 4 months prior to separation, noted complaints of right leg pain.  The CI could perform aerobic exercise under modified conditions, but was unable to satisfactorily complete a physical fitness test.  Physical examination showed tenderness of the anterior right leg from the knee joint line to approximately five inches below the knee and was otherwise unremarkable.   

The CI was unable to attend a scheduled VA Compensation and Pension examination on 20 April 2005.  He withdrew the claim and planned to refile at a later date, however there was no evidence in record that a VA exam was performed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain, due to tibial stress fractures condition 10%, under the analogous code 5003 (arthritis, degenerative), citing U.S. Army Physical Disability Agency (USAPDA) pain policy as slight and constant pain.  The PEB assigned a 10% rating for the right leg pain and the panel reviewed to see if a higher rating was supported by the evidence.  There is no higher rating for a single joint, or analogously coded as 5099-5003 for a single extremity as in this case.  The CI was documented to have a non-healing stress fracture and the panel considered coding as analogous to tibial impairment (5262) for malunion.  However, there was no evidence of knee or ankle disability that could be characterized as “moderate” for the 20% rating.  Likewise, there was no evidence of limited knee motion (5260, 5261) or ankle motion (5271) due to the stress fracture for a higher rating under the applicable codes.  There was therefore no higher rating than 10% available under any applicable VASRD code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and a 10% rating is supported under 5099-5003 according to VASRD rating criteria as well.  Therefore no change is recommended to the PEB coding.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic pain due to tibial stress fractures condition.  

BOARD FINDINGS:  In the matter of the chronic pain due to tibial stress fractures condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150531, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,