RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01025
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E1, Calvary Scout, medically separated for “left proximal third tibial stress fracture…” with a disability rating of 20%.

CI CONTENTION:  The CI requested a review of all conditions.  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 - 20090520	VARD - 20140807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Proximal Third Tibial Stress Fracture…	5299-5262	20%	Status Post Fracture Left Tibia	5262	10%	20140730	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Proximal Third Tibial Stress Fracture.   According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced acute onset of left tibia pain in January 2009 after a road march during basic training.  Radiographs taken at the time demonstrated a nondisplaced proximal tibia fracture.  The CI subsequently underwent surgery.  Post-operatively, he was placed on crutches and progressed satisfactory, although he continued to have pain.  His condition precluded him from returning to strenuous physical activity; therefore, he was referred to the MEB.  The MEB forwarded “left proximal third tibial stress fracture…” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 29 April 2009, 5 weeks prior to separation, the CI reported pain in his knee and that his knee locks and gives out.  Physical exam noted “mild weakness and muscle atrophy of the left lower extremity.  The MEB NARSUM examination on 21 April 2009, 6 weeks prior to separation, noted complaints of left leg pain that prohibited walking greater than 50 meters before experiencing increase in pain.  The examiner noted that the CI presented to the examination using crutches.  Physical examination showed left leg with well-healed surgical scars that were non-tender.  There was tenderness to palpation over the proximal third of the left tibia.  There was no swelling and the left knee was stable on testing.  Range of motion (ROM) testing revealed flexion to 130 degrees (normal 140) without pain.  

There was no VA examination in evidence within the 12-month allowable window for adjudication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left lower extremity condition 20%, coded analogously 5299-5262 (impairment of tibia and fibula) for moderate disability.  The higher rating of 30% requires the demonstration of marked knee or ankle disability.  The panel noted that the CI’s physical profile did not allow running; however, did allow walking and biking at own pace and distance, and lower body weight training.  The NARSUM examiner did not document the presence of muscle atrophy or weakness during the physical examination, although the MEB physical examination documented “mild weakness and muscle atrophy.”  Panel members agreed, based on the clinical evidence, the higher rating of 30% for marked disability was not justified.  There was no documented evidence of recurrent subluxation or lateral instability to justify a rating under the 5257 code, and there was no additional applicable codes to consider.  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 left leg condition.  

BOARD FINDINGS:  In the matter of the left proximal third tibial stress fracture status post IM nailing condition and IAW VASRD §4.71a, the panel 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008423, XXXXXXXXXXXXXXXXXX

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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,