RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01119
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Pharmacy Specialist, medically separated for “bilateral leg pains with stress reactions of both tibias,” with a disability rating of 0%.

CI CONTENTION:  “Review 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 - 20041116	VARD - 20050729	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Leg Pain w/Stress Reactions of Both Tibias	5022	0%	Right Tibial Stress Reaction 	5299-5262	0%	20050505	
			Left Tibial Stress Reactions	5299-5262	0%		
Bilateral Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Leg Pain w/Stress Reactions of Both Tibias.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower extremity pain began in the left leg in late 2002 and became bilaterally present in 2004 without history of trauma or injury.  A bone scan revealed bilateral tibial stress reactions.  Despite non-surgical treatment, the bilateral tibial pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bilateral tibial stress reaction” for PEB adjudication.
At the 12 October 2004 MEB NARSUM examination, 5 months prior to separation, the CI’s chief complaint was “pain in both lower legs.”  He additionally endorsed a pain level of 6/10 present 24 hours per day.  His listed abnormal physical examination (PE) findings on the NARSUM were tenderness to both lower legs as assessed from an evaluation performed on 27 September 2004 (2 weeks prior to the NARSUM).  

At the 5 May 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported constant bilateral lower extremity pain which inhibits his ability to stand or walk for a prolonged period of time.  His lower extremity focused PE was completely normal.  Repeat plain X-rays of both legs were without bony abnormality.  In regards to the CI’s history of bilateral tibial stress findings, the VA examiner noted the following: “…there is no diagnosis.  There is no pathology to render a diagnosis.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral tibial pain condition at 0%, coded 5022 (periostitis).  The VA diagnosed the same condition and separately rated the right and left leg at 0%, analogously coded 5299-5262 (tibia/fibula impairment), based upon the VA C&P examination 2 months after separation.  
  
The panel first considered whether each lower extremity condition remained separately unfitting, having decoupled them from the combined (bilateral) PEB adjudication.  Panel members carefully reviewed the chronological STR as well as post-separation VA encounters and agreed that the CI’s overall condition, isolated treatments, and generally unchanging clinical symptoms did not significantly center about either leg independently, but rather a bilateral condition.  Panel members found it reasonable to surmise that it was the combination of pathology from both lower extremities that rendered the CI unfit to perform his military speciality duties.  

In regards to specific rating criteria, members agreed that the sole evidence of tibial tenderness at 5 months prior to separation which improved to reveal a normal examination at 2 months post-separation would not equate to support any positive impairment rating.  Members concluded that a bilateral rating of 0% was appropriate to the pathology and disability in this case.  Therefore, 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’s adjudication for the bilateral leg condition.
  
Contended PEB Condition:  Bilateral Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the bilateral pes planus condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the 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 the contended condition and so no additional disability rating is recommended. 

BOARD FINDINGS:  In the matter of the bilateral leg condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral pes planus condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are 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 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170010608, 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,