RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01398
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Information System Operator, medically separated for “left leg pain,” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20030620	VARD - 20071227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Leg Pain	5099-5003	0%	Left Hip Condition	5299-5252	NSC	20071029	
			Left Knee Condition	5299-5757	NSC	20071029	
			Left Ankle Condition	5299-5271	NSC	20071029	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY: 

Left Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg condition began in July 2002 during basic training.  The CI twisted his left ankle and fell on his left knee.  He was diagnosed with an ankle sprain, pes planus, and shin splints.  In September 2002 a bone scan was interpreted as shin splints.  Notes in the record indicated that the CI was treated for shin splints with knee, shin and ankle pain from July 2002 to December 2002.  At 12 December 2002 physical therapy evaluation, the CI reported new pains of the bilateral hips and left knee, but noted the shin pain was 60% better.  On 6 January 2003 left hip and left tibia/fibula X-rays were normal.  On 13 January 2003 left foot x-rays were normal.  At the 16 January 2003 physical therapy visit, the CI reported anterior leg pain, left greater than right, and that the hip and knee pain had mostly resolved.  The CI was screened for underlying systemic inflammatory disorders.  At the March 2003 primary care evaluation, the CI complained of bilateral whole leg pain, much greater on the left than right.  On 28 March 2003 bone scan showed “mild uptake” in the left hip consistent with arthritis, “minimal” stress reaction in the left tibia, but no evidence of stress fractures.  On 22 April 2003 orthopedic evaluation noted full hip ROM (flexion, extension, internal and external rotation) with painful motion on the left.  There was tenderness of the left knee joint line without effusion.  There was no tenderness of the right knee.  Bilateral ankle ROM was full with some tenderness of the ankle.  There was mild weakness of the bilateral lower extremities graded 4+/5.  Reflexes and pulses were normal.  Magnetic resonance imaging of the left hip noted no abnormality except swelling of the gluteal muscle.  The orthopedic assessment was “likely overuse syndrome.”  

The MEB NARSUM examination on 28 April 2003, 4 months prior to separation noted the CI was not taking any medications for the pain.  He was not participating any unit physical training.  He was attending physical therapy periodically.  Physical examination showed no swelling or muscle atrophy of the left leg.  There was “full ROM” of the left hip, knee, ankle, and foot.  The CI was able to walk on his heels and toes.  The neurological examination was normal and the examiner indicated the reminder of the examination was unremarkable.  The MEB NARSUM examiner determined that the CI fell below retention standards due to “left whole leg pain of unknown etiology.”  The 29 October 2007 VA Compensation and Pension (C&P) evaluation, performed over 4 years after separation, was too remote from separation to have probative value for the panel’s rating recommendation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg pain condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the USAPDA pain policy.  The bone scan noted mild uptake in the left hip consistent with arthritis.  However, at the MEB NARSUM examination there was no evidence of painful limited hip ROM to support a 10% rating under 5003 (or related code) or 5299-5252 (limitation of thigh flexion), based on §4.59, §4.40, §4.45.  There was no limitation of motion which supported a 10% rating under the diagnostic codes for limitation of thigh flexion, extension, or thigh impairment (5252, 5251, 5253) and there was no evidence of femur impairment (5255) to warrant rating under 5255.  The CI was diagnosed and treated for shin splints with a positive bone scan, the panel therefore also considered if the evidence supported a higher rating than 0% under a VASRD knee or ankle code, but there was no evidence of sufficient limitation of knee or ankle ROM (5260/5261, 5271) to warrant rating under these codes and no evidence of painful knee or ankle ROM for a minimum 10% rating (based on §4.59, §4.40, §4.45) for either joint or due to tibial impairment (5262).  There was no other ratable impairment of the hip, knee or ankle identified.  There was therefore no route to a rating higher than 0% under any applicable code for the left leg pain condition.  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 pain condition.  

BOARD FINDINGS:  In the matter of the left leg pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007577, 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