RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01838
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Optical Laboratory Specialist, medically separated for “bilateral tibial pain,” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20030226	VARD - 20040319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Pain	5099-5003	0%	Right Shin Splints	5099-5024	0%	20031009	
			Left Shin Splints	5099-5024	0%	20031009	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Tibial Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral tibial pain condition began in October 2000 while performing unit physical training.  X-rays, MRIs, and bone scan studies were normal.  At the 27 January 2003 MEB NARSUM examination, 4 months before separation, the CI reported bilateral leg pain.  Physical examination was normal except for tenderness along the front and inside aspects of both lower legs.

At the 9 October 2003 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported infrequent flare-ups of bilateral shin pain without any further treatment since leaving the service.  Physical examination revealed mild tenderness to the front aspects of both tibias without edema, heat or erythema (reddening of the skin).  Bilateral X-rays showed no fracture of bony destruction.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral tibial pain condition at 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated each leg (shin) 0%, analogously coded 5099-5024 (tenosynovitis), based upon the C&P examination 4 months after separation, citing there was no objective evidence of painful or limited motion of a major joint or group of minor joints.  The panel first considered whether each lower extremity condition remained separately unfitting, having decoupled them from the combined (bilateral) PEB adjudication.  Panel members carefully reviewed the chronological STR as well as post-separation VA encounters and the panel consensus agreed that the CI’s overall condition, isolated treatments, and generally unchanging clinical symptoms did not significantly center about either leg independently, but rather a bilateral condition.  The panel majority found it reasonable to surmise that it was the combination of pathology from both lower extremities that rendered the CI unfit to perform his military specialty duties.

All panel menders agreed that the MEB NARSUM evidence of bilateral tibial tenderness which improved to mild tibial tenderness without edema, heat, erythema and negative X-rays documented by the C&P examination, 4 months after separation, did not support a 10% rating IAW VASRD §4.59 painful motion or limited motion.  Member majority concluded that a bilateral rating of 0%, was appropriate to the pathology and disability in this case.  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’s adjudication for the bilatera tibial pain condition.

BOARD FINDINGS:  In the matter of the bilateral leg condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB’s adjudication.  The single voter if dissent recommended rating both tibias separately at 0% 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, 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/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009169, 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.

Sincerely,