RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01399
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Light Wheel Vehicle Mechanic, medically separated for “chronic bilateral shin pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 - 20060323	No VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Shin Pain…	5022	0%	No VA Claim on file	--	--	--	
RATING:  0%	RATING:  N/A	

ANALYSIS SUMMARY:  

Chronic Bilateral Shin Pain.  The PEB combined the left and right shin pain conditions as a single unfitting condition coded 5022 (Periostitis) and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral shin pain condition is presented, with attendant recommendations regarding separate unfitness and separate rating if indicated.  

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic bilateral shin pain condition began approximately January 2005.  Radiographic evaluations demonstrated bilateral tibial stress related changes.  The CI was treated with crutch ambulation and pain medications.  Despite treatment, the bilateral shin pain condition could not be adequately rehabilitated for resumption of dull duties.  At a physical therapy appointment on 9 January 2006, painful range of motion of the left knee was 135 degrees flexion (normal, 140 degrees) and -5 degrees extension (normal, 0 degrees).  There was painful motion the right knee with decreased motion of 115 degrees flexion (normal, 140 degrees) and -5 degrees extension (normal, 0 degrees).  

The MEB NARSUM examination on 27 February 2006, 2 months prior to separation, noted complaints of bilateral shin pain.  The examiner did not perform a physical examination of the area at the time of the NARSUM examination.  The CI’s file contained a permanent profile for bilateral tibial stress reactions dated 1 December 2005.  The commanders statement noted that the CI could not “kneel, jump, march, squat, stand for long periods of time, or lift over 30 pounds, therefore was not able to perform tasks that were required in the daily operations of his military occupational specialty (MOS).  There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel first considered if each lower extremity, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Both extremities were profiled and implicated in the commander’s statement.  There was radiogphic evidence of bony pathology for both lower extremities and both were treated.  Panel members agreed that the evidence supports that each lower extremity was reasonably justified as separately unfitting. 

The panel then considered its rating recommendation for the unfitting left and right shin pain conditions at the time of separation.  The PEB rated the condition at 0%, citing stress reactions not resulting in abnormal range of motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each lower extremity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for each lower extremity, coded 5022; a combined 20% rating.  

BOARD FINDINGS:  In the matter of the chronic bilateral shin pain condition, the panel majority recommends a disability rating of 10% coded 5022 IAW VASRD §4.40 and §4.59 for each, right and left, chronic shin pain; a combined rating of 20%.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  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	
Chronic Left Shin Pain	5022	10%	
Chronic Right Shin Pain	5022	10%	
COMBINED w B/L	20%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007579, 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