RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01558
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “right leg pain secondary to tibial stress fracture…” with a disability rating of 0%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect 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 - 20041220	VARD - 20050510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Leg Pain Secondary to Tibial Stress Fracture	5022	0%	Right Tibia Stress Fracture	5299-5262	0%	20050307	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Stress Fracture.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an onset of right leg pain early in basic training in July 2004 (~5 months before separation).  A right proximal tibial stress fracture (versus reaction) was diagnosed on bone scan, and the CI was treated with casting and progressive ambulation.  There was no evidence addressing range of motion (ROM), painful motion, or other ratable features in STR clinical entries, and it appeared that the CI remained on crutches at the closure of the MEB period.  Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow a timely resumption of training; and the CI was referred for an MEB.

The 1 December 2004 NARSUM examination, 2 months before separation, documented persistent pain (unelaborated) and continued use of crutches “that prohibits him from all functional activities.”  The examiner recorded an “unremarkable” physical examination except for right tibial tenderness without swelling, deformity, or neurovascular compromise.  There was no directed comment regarding ROM, painful motion, or other ratable features.

A 7 March 2005 VA Compensation and Pension (C&P) examination on, 2 months after separation, documented “intermittent sharp pain which is mild to moderate in intensity ... [that] ... lasts for a few seconds;” and, the examiner opined that it did not limit daily activities or result in any occupational impairment.   The physical examination recorded a normal gait without crutches or assistive device, “mild” right tibial tenderness with no other positive findings, and “full” ROM of the right knee and ankle without note of painful motion.  A VA X-ray was normal and a bone scan demonstrated mildly delayed uptake consistent with a near-healed stress reaction.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg pain condition 0%, coded 5022 (periostitis) citing “without loss of motion of the contiguous joints.”  The VA rated the right leg pain condition 0%, coded analogously as 5262 (tibia and fibula, impairment of) based on the C&P evidence, citing failure to meet the minimum compensable “slight” criterion.  

Other than rating under criteria of 5003, as per the PEB, or analogously to 5262, as per the VA, there are no coding options under the VASRD which are applicable (even analogously) to this case.  Although there was no directed evidence regarding ROM or painful motion in the service file, members agreed that it would be overly speculative (e.g., not clinically consistent) to invoke either ROM limitation or painful motion at the knee or ankle as a basis for recommending a minimum compensable 10% rating under criteria of 5003.  Since the CI had not fully recovered at the time of separation, the functional evidence in the NARSUM might be invoked to entertain a higher rating under the VA code 5299-5262; but, members agreed that the nature of the pathology and disability was most accurately portrayed by the C&P evidence soon after separation (after near-complete healing).  It was also agreed, as concluded by the VA rater, that the functional evidence documented by the C&P examiner did not satisfy the minimum 10% criterion of “slight” disability at that time.

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 of the right tibial stress fracture.

BOARD FINDINGS:  In the matter of the right tibial stress fracture 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008523, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX

	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.