RECORD OF PROCEEDING
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01328
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an  E3, Military Police, medically separated for “chronic right thigh pain secondary to rectus muscle strain” and “left lower extremity stress reaction,” rated 0% and 0%, respectively, with a combined disability rating of 0%.

CI CONTENTION:  The CI detailed continued back pain, right leg, and has developed depression.  The CI’s 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 -20060321	VARD - 20060824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Thigh Pain…	5314	0%	No VA Placement	
Left  Lower Extremity Stress Reactions	5022	0%	Left Knee Pain	5257	NSC	20060614	
			Left Tibial Stress Fracture 	5299-5262	NSC	20060614	
			Left Ankle Pain	5271	NSC	20060614	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --	

ANALYSIS SUMMARY:  

Chronic Right Thigh Pain Secondary to Rectus Muscle Strain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right thigh condition began in April 2005.  In April 2005, the CI noted a painful lump in her right mid-thigh.  No trauma or injury was reported.  In July 2005, a bone scan revealed a “healing stress fracture of the right femur.  In late October 2005 a repeat bone scan did not note any persistence of increased uptake in the right femur.  

At the 10 November 2005 MEB orthopedic consult, 5 months before separation, the CI reported a right thigh mass that was painful and aggravated by load bearing activities.  On 4 November 2005 magnetic resonance imaging (MRI) of the right thigh showed a partial tear of the rectus femoris muscle and the CI was diagnosed with a “chronic thigh rectus strain.”  The physical examination showed a normal gait.  There was no significant swelling of the right thigh.  The examiner noted a possible broad based mass under the rectus femoris that was mildly tender to palpation.  The CI was able to extend her leg fully against resistance with full strength and no apparent pain.  There was no tenderness to bony palpation.  At the November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation there was tenderness to palpation of the proximal right thigh.  

At the 23 February 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain in the right thigh about “70% of the time.”  The CI reported the pain was aggravated by weight bearing activities and denied limping.  She was taking medications for chronic pain and was weaning off opiate pain medication.  Physical examination cited the DD Form 2808 examination and the MEB orthopedic consult both noted above.  

At the 14 June 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported right thigh pain with weakness.  Physical examination showed a normal gait.  There was some swelling of the right knee noted.  Right knee range of motion was normal with no painful motion noted and no additional loss of motion with repetition of motion.  There was no motor loss of the right side.  Knee and ankle reflexes were normal.  Right femur and knee X-rays were normal.  Under additional comments, the VA examiner noted “mild” atrophy of the rectus femoris (VASRD 4.73 Group 14 XIV muscles) with no significant effect on occupational activities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right thigh pain condition 0%, coded 5314 (Group XIV – anterior thigh group muscles), citing slight muscle injury.  The VA did not service connect any condition of the right thigh or extremity based on the C&P examination 2 months after separation.  The rating criteria of 5314 are subjective, with a 0% rating for “slight”, 10% rating for “moderate” muscle injury.  The discrimination between the `slight’ and `moderate’ characterizations depends on the presence of at least one “cardinal sign or symptom” of muscle injury specified as “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement” for “moderate”, as opposed to none for “slight”.  The CI reported right thigh pain present 70% of the time at the MEB NARSUM examination.  At the VA examination mild atrophy of the rectus femoris muscle was noted with no significant functional effect.  The panel judged that the right thigh muscle injury did not rise to the threshold of moderate muscle injury based on the CI’s normal strength and gait at both the MEB NARSUM and VA examinations and the intermittent nature of the right thigh pain, which was reasonably anticipated to further improve following separation from the rigors of the military lifestyle.  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 right thigh pain condition.

Left Lower Extremity Stress Reaction Diagnosis.  According to STR and the MEB NARSUM, the CI’s left lower extremity stress reaction condition began in March 2005.  The condition started when the CI noted an onset of “swelling” in her left tibia.  The CI was initially diagnosed with shin splints in the left lower leg.  In March 2005 radiographic studies of left leg showed a possible stress reaction of the tibia.  In July 2005 the bone scan study showed significant stress reaction in the medial tibial plateau (MTP) and obvious stress fracture of the left tibial shaft.  On 24 October 2005 a repeat bone scan showed a healing “occult fracture” of the left tibia and a normal reaction at the MTP.  

At the 10 November 2005 MEB orthopedic examination, 5 months prior to separation the CI reported left leg pain since basic training in the mid-shaft of the tibia, aggravated by weight bearing activities, with occasional swelling.  She reported the left leg pain had been getting progressively better.  The physical examination showed a normal gait.  There was no swelling of the left leg.  There was focal tenderness over the site of the stress fracture of the tibia.  There was no pain with heel tap and the extremity was neurovascularly intact.  Left tibia X-rays showed continued healing of the left tibial stress fracture.  At the November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation physical examination showed tenderness to palpation of the proximal left tibia.  

At the 23 February 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain in the left lower leg about “50% of the time.”  She had no complaints regarding the right lower leg.  Physical examination cited the DD Form 2808 examination and the MEB orthopedic consult both noted above.  

At the 14 June 2006 C&P evaluation, performed 2 months after separation, the CI reported stress fracture of the left tibia with tingling from the knee to the ankle.  She reported the left leg felt weak at times.  Physical examination showed a normal gait.  Left knee and ankle ROM were full without painful motion noted and without additional loss of motion with repetitive motion.  Left lower extremity strength, sensation, and reflexes were normal.  Left knee, tibia/fibula, and ankle X-rays were normal.  Under additional comments, the VA examiner noted a normal examination of the left tibia with no significant effect on occupational activities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left lower extremity stress reaction condition 0%, coded 5022 (periostitis), citing periostitis without loss of motion of contiguous joints.  The VA did not service connect any condition of the left lower extremity based on the C&P examination 2 months after separation.  

There was no evidence of painful limited motion with imaging evidence of pathology for 10% rating under 5022 or evidence of painful motion of the left knee or ankle supporting a 10% rating coded as 5299-5260 (limitation of leg flexion) or 5299-5271 (limitation of ankle motion), based on §4.59, §4.40 and §4.45.  There was likewise no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of knee flexion or extension (5260, 5261) or limitation of ankle motion (5271).  There was therefore no higher rating than 0% available for the left lower extremity stress reaction condition under any applicable VASRD code.  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 lower extremity stress reaction condition.

Contended PEB Conditions:  Low Back Pain.  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 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 chronic right thigh pain condition and IAW VASRD §4.73 the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left lower extremity condition and IAW VASRD §4.71a the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended low back pain 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 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

AR20170007554, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure