RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01796
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “chronic pain, left leg, due to tibial stress fracture” with a disability rating of 10%.

CI CONTENTION:  The CI contends the pain in his knees continues to worsen.  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 - 20061010	VARD - 20070131 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Leg, due to Tibial Stress Fracture	5099-5003	10%	Stress Fracture of the Proximal Left Tibia with Shin Splints	5299-5262	10%	20061009	
Splints Tibias Bilateral	Not Unfitting	Shin Splints, Right Lower Leg	5099-5024	0%		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Leg, due to Tibial Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg pain began in May 2006 during basic training.  The CI developed left leg pain and a bone scan showed an oblique stress fracture of the left tibia and mild stress reactions of the right and left tibial shafts referred to as “shin splint changes.”  Magnetic resonance imaging showed a non-displaced spiral fracture of the proximal tibial.  At an orthopedic evaluation on 11 July 2006 the CI was noted to have generalized joint hyperlaxity and significant genu recurvatum bilaterally, indication.
The permanent profile dated 15 August 2006 listed “closed stress fracture of the left tibia proximal” as a permanent L3, with “shin splints bilateral” as temporary L3.  The commander’s statement indicated “lower extremity stress fractures” prevented the CI’s successful performance of his duties.  

The 16 August 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain in the left leg near the knee.  Physical examination showed tenderness and swelling over the proximal one third of the tibia.  There was no tenderness or swelling in the area of the left or right shin splints.  The MEB NARSUM examiner noted that the CI was having pain on walking, running, jumping, marching and standing which prevented him from completing his basic training in the near future.  

At the 9 October 2006 VA Compensation and Pension (C&P) evaluation, 2 weeks before separation, the CI reported localized pain in the left tibia, aggravated by weight bearing activities.  The VA examiner noted the CI could perform activities and functions of walking, climbing stairs, taking out the trash, driving, shopping and performing yard work.  Physical examination showed a normal gait.  There was a bony prominences and tenderness of the anterior left tibia.  Genu recurvatum (hyperextension) of 20 degrees of both knees was noted (normal 0) with flexion of 140 degrees (normal 140).  There was no additional limitation due to pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  There was no evidence of instability or meniscal injury.  Examination of the left ankle was normal with full range of motion.  Left tibia/fibula X-rays showed an old healed fracture and left knee X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg pain 10%, analogously coded 5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left leg pain 10%, coded 5262 (tibia and fibula, impairment of), based on the C&P examination 2 weeks before separation, citing impairment (stress fracture of left tibia with shin splints) of the left tibia with slight knee disability.

The PEB assigned a 10% rating for the chronic left leg pain condition and the panel therefore reviewed to see if the evidence supported a higher rating.  There is no higher rating of a single joint under 5003.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of knee flexion or extension (5260, 5261) or limited ankle motion (5271).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes. There was a fracture of the tibia to support consideration under the code for knee impairment related tibial impairment (5262).  However, there was no evidence to support characterizing the knee disability due to the left tibial fracture as moderate for higher rating under 5262 and there was no evidence of related ankle disability.  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable 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 leg condition.  

Contended PEB Condition:  Splints tibias bilateral (bilateral shin splints).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The bilateral shin splints were profiled, but were not judged to fail retention standards.  The commander’s statement implicated “lower extremity stress fractures” but this may have referred to the left lower extremity only, as an oblique fracture and other areas of increased bone reaction (“shin splints changes”) were noted in the LLE.  The CI never reported pain of the right leg in the available STR or at the NARSUM examination.  There were no objective clinical findings related to the shin splint areas of either leg noted at the NARSUM or the VA examinations.  There was no performance-based evidence from the record that the right leg condition significantly interfered with satisfactory duty performance at separation and any pain due to the left shin splints is subsumed in the rating recommendation for the left tibial stress fracture.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the bilateral shin splints and so no additional disability rating are recommended.  

BOARD FINDINGS:  In the matter of the “chronic pain left leg” condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended “splints tibias bilateral” condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20150706, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20170008936, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
						      					
Enclosure