RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01186
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061010

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “left lower extremity pain secondary to stress fracture of the distal tibia,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 - 20060725	VARD - 20150716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Lower Extremity Pain	5099-5022	0%	Left Tibia Stress Fracture	5299-5262	10%	20150622	
Mild Bilateral Pes Planus	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Lower Extremity Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented with lower left extremity (LLE) pain in July 2004 when he noted a several week history of pain aggravated by activity.  X-rays were normal and he was treated with limited duty.  A bone scan was also ordered, but the CI did not report for the appointment.  On 17 August 2004, he reported ongoing LLE pain at an acute appointment for leg pain and a sore throat.  He was thought to have an ongoing stress reaction (shin splints) and the bone scan was reordered.  On 1 September 2004 it confirmed bilateral shin splints and a stress fracture of the left tibia (shin bone).  He was continued on limited duty (no impact activity) and non-steroidal anti-inflammatory drugs (NSAIDs).  He deployed from 29 July 2005 to 3 December 2005 with aggravation of his pain.  He was issued crutches and placed non-weight bearing.  He was also issued orthotics (shoe inserts) for bilateral flat feet (pes planus).  At a follow up appointment on 7 February 2006, it was noted the CI was not using the orthotics and was not observing the non-weight bearing restrictions.  He was then placed in a cast.  X-rays of the left lower leg that day were normal.  A repeat bone scan showed some stress changes in the ankle, but no definitive findings of an ongoing stress fracture.  This was noted by orthopedics to be equivocal.  X-rays of the left ankle on 23 March 2006 were normal.  Clinically his diagnosis remained consistent with a left shin stress fracture and an MRI of the left ankle was done on 13 April 2006.  It showed changes associated with disuse, but no evidence of a fracture.  The CI was then referred to an MEB for non-compliance and for failure to improve.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 8 May 2006, 5 months prior to separation, the CI reported continued shin pain.  On examination, he was mildly tender to touch over the mid tibia (shin bone), but without swelling.  He had no pain standing on his toes.  The MEB NARSUM examination was dated 30 May 2006, 4 months prior to separation, noted complaints of pain with running from the pes planus.  The examination of the feet was unremarkable.  The shins were tender to touch, with the left more tender than the right.  No abnormalities of the ankle or knee were noted on this examination or the prior MEB 2808 examination; however, he was noted to remain symptomatic in the area of the old stress fracture.  The MEB forwarded lateral tibial stress reaction syndrome (shin splints) of the LLE for PEB adjudication.  The VA Compensation and Pension (C&P) evaluation was performed on 22 June 2015, almost 9 years after separation, and was not probative for rating the condition at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LLE condition 0%, 5099-5022 (analogous to periostitis), citing a stress fracture of the LLE.  The VA rated left tibia stress fracture condition 10% coded 5299-5262 (analogous to impairment of the tibia and fibula), citing impairment at the slight level.  The panel considered the evidence.  The CI was tender over the shins, the left more than the right.  No pathology of the knee or ankle was recorded by the examiner.  X-rays of the left ankle and shin were normal.  An MRI of the left ankle was essentially unremarkable.  A bone scan in March 2006 was noted by orthopedics to be equivocal, but changes associated with a stress fracture of the mid-tibiae were not present.  The evidence does not support an ongoing stress reaction (shin splint) at separation; however, per the NARSUM, the CI consistently demonstrated tenderness near the site of the old stress fracture.  The panel determined the LLE condition supported a 10% rating using the analogous code 5299-5262 for a slight impairment.  

Contended PEB Conditions:  Mild Bilateral Pes Planus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, 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 (left) lateral tibial stress reaction syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5262 IAW VASRD §4.71a.  In the matter of the contended bilateral pes planus conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 Lower Extremity Pain	5299-5262	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005810, 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