RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2015-01069
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “bilateral shin splints,” rated 10% left and 10% right, with a combined disability rating of 20%.  

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  His 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 - 20090723	VARD - 20091208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
[Left] Shin Splints	5099-5022	10% 	Bilateral Shin Splints	5299-5262	NSC	20091026	
[Right] Shin Splints	5099-5022	 10%					
Healed Right Tibia Stress Fracture	Not Unfitting	No VA placement	
Congenital Foot Deformity-Talipes	Not Unfitting	No VA placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Shin Splints.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral shin condition began in December 2008 during basic training without any specific injury or trauma.  Radiographic imaging (bone scan) in January 2009 documented bilateral mid tibial shin splints.  Bilateral shin tenderness and swelling was noted at 3 clinic visits in January 2009.  Subsequent visits in February, March, and April 2009 noted normal gaits and only right shin tenderness.  At clinic visits in late April, May, and June 2009, recurrence of the bilateral tibial tenderness was noted with increasing activity; normal gaits were documented.  Radiographic evaluations (X-rays) in June 2009 documented “persistent or worsening shin splints” bilaterally.  

The 9 July 2009 MEB NARSUM examination, 1 month prior to separation, noted complaints of chronic bilateral leg pain with prolonged walking, standing, running, lifting, or road marching.  The physical examination showed ambulation without pain and no tenderness or swelling of the bilateral lower extremities.  There was near full range of motion (ROM) of the bilateral knees (0-130 degrees bilaterally; normal is 0-140) without additional loss of ROM, or functional loss due to pain, or weakness on repetition.  The bilateral ankle ROMs showed 15 degrees of dorsiflexion (normal 20) and 35 degrees of plantar flexion (normal 45) with no evidence of instability; and without additional loss of ROM due to pain or weakness on repetition.  

At the 26 October 2009 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI denied any effect on daily activities since leaving the military, and denied flare ups, swelling, or use of assistive devices or corrective shoes or inserts.  The physical examination showed normal gait and heel to toe walk, with no limitation while standing and walking.  There was no evidence of swelling or tenderness of the shins.  Bilateral knee and ankle ROMs were normal.  Radiographic evaluation (X-rays) of the bilateral tibias showed no evidence of stress fracture.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% each for the right and left shin splint conditions, combined 20%, analogously coded 5099-5022 (periostitis), citing painful motion and functional loss IAW VASRD §4.10, §4.40, §4.45, and §4.59.  The VA did not grant service connection based on the October 2009 VA C&P examination and on the lack of evidence of a chronic disability.  The panel considered the evidence for a higher rating of either of the tibial shin splints.  In this case, there were no significant distinctions with regards to the clinical features of the right and left shins.  Treatment records indicated bilateral shin tenderness, pain with use, and normal gaits with radiographic evidence of bilateral shin splints.  The NARSUM examination documented resolution of tenderness and normal ambulation.  The post-separation C&P examination documented no clinical or radiographical evidence of bilateral shin splints.  There was no evidence of more significant ROM limitations of the knees for higher rating under codes 5260, (limitation of flexion), or 5261, (limitation of extension), and that no rating higher than 10% was supported under code 5262, (tibia and fibula, impairment of).  The panel agreed that there was no evidence of “moderate” or “marked” ankle disability, therefore a higher rating was not justified under 5271.  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 right or left shin splint conditions.  

Contended PEB Conditions:  Healed Right Tibial Stress Fracture and Congenital Foot Deformity- Talipes.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Although both of the contended conditions were profiled, neither of them were specifically implicated in the commander’s statement and neither of them were judged to fail retention standards.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right and left shin splint conditions and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended healed right tibial stress fracture and congenital foot deformity- talipes, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

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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,