RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01527
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E1, Basic Trainee, medically separated for “stress fracture left tibia,” 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 panel 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 determinations 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 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 - 20071211	VARD - 20090121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Left Tibia	5099-5022	0%	Stress Fracture, Left Tibia	5262	0%	20090226	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Stress Fracture, Left Tibia.  There was a paucity of source clinical notes in the available service treatment record (STR) for this case, and the Board’s recommendation was derived primarily from the Medical Evaluation Board (MEB) narrative summary (NARSUM), core military Disability Evaluation System documents, and probative VA evidence as elaborated below.  The CI developed left ankle pain after her first exposure to ruck marching in the second week of basic training.  Although an X-ray was normal, a bone scan indicated the presence of an “early” stress fracture of the distal tibia.  There was no STR documentation of instability, range of motion (ROM) limitation, or other ratable finding.  Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow the CI to resume training in a timely fashion; and, podiatry recommended MEB which in turn forwarded “left tibia stress fracture” to the PEB.  The NARSUM examination on 31 October 2007 (3 months before separation) documented “increasing pain” prohibiting running, jumping, or marching and the use of a cam walker (removable boot brace).  The physical examination recorded tenderness over the medial ankle, “no ligamentous laxity,” and a normal foot arch.  Formal ROM measurements were not provided, although the examiner stated “mild pain on [ROM] to the left ankle.”  The CI failed to report for an initially scheduled VA examination, but there was a VA Compensation and Pension (C&P) examination dated 26 February 2009 (14 months after separation).  The C&P documented pain 3 hours out of the day rated 4/10, and noted only running as a functional limitation.  The physical examination recorded a normal gait (no brace or assistive device), ankle tenderness, no swelling, no instability, and normal findings for the foot.  Measured ankle ROM was normal (dorsiflexion 20 degrees and plantar flexion 45 degrees).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5099-5022 (analogous to periostitis) cited “no mechanical loss of motion” suggesting application of Army Regulation 635-40 (B-29, e).  The Service regulation circumvented VASRD §4.59 (painful motion); and, members agreed the NARSUM documentation was sufficient to support application of §4.59 providing for the minimum compensable rating (10%).  Furthermore, members agreed there was sufficient evidence to justify application of VASRD §4.40 (functional loss) in support of the minimum compensable rating.  The VA rated 0% under code 5262 (tibia and fibula, impairment of), both in its initial decision based on the STR evidence and in its subsequent decision based on the above C&P evidence, citing failure to meet the minimum compensable rating (10% for “slight” disability of the contiguous ankle).  Code 5262 additionally offers a 20% rating for “moderate” and 30% for “marked” ankle disability; but, members agreed this code, which rates for complications of displaced fractures (not the case here) was marginally applicable; and not favorable since the functional evidence was not consistent with moderate or greater disability.  There was no evidence for ROM limitation or any other ratable criterion that would justify a rating higher than 10% under any other applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left tibial stress fracture under code 5099-5022.    

BOARD FINDINGS:  In the matter of the left tibia stress fracture, the Board unanimously recommends a disability rating of 10%, coded 5099-5022 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.   

The Board 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	
Stress Fracture, Left Distal Tibia	5099-5022	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006471, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	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