RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01862
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E1, Basic Trainee, medically separated for “bilateral stress reactions of the tibia (periostitis),” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “I have been out for 7 years and I can’t run or job without the pain shooting up from my feet.”  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 - 20080415	VARD - 20111005	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Stress Reactions of the Tibia (Periostitis)	5022	20%	Bilateral Leg Condition	5284	NSC	20110818	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Stress Reactions of the Tibia (Periostitis).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain condition began in November 2007 during Basic Training.  A bone scan was obtained and showed multiple stress fractures.  Despite being placed on crutches and 30 days of unit convalescence leave and physical therapy, the CI’s condition did not improve sufficiently enough to allow for unrestricted duty.

At the MEB examination (recorded on DD Forms 2807 and 2808) on 4 March 2008, 2 months prior to separation, the CI reported she had difficulty with sleep due to her leg pain.  Physical examination of the lower extremities was deferred.

The MEB NARSUM examination on 10 March 2008, 2 months prior to separation, noted complaints of chronic bilateral lower extremity pain secondary to multiple stress fractures.  The CI reported her pain occurred intermittently and that she did not have pain at rest or when sitting.  Activities such as prolonged standing or walking increases her pain and she could only walk a short distance.  The pain was located in bilateral knees and ankles.  She was not taking any medications for the pain.

Physical examination was unremarkable.  The range of motion (ROM) recorded by physical therapy 2 months prior to separation, documented right knee flexion of 135 degrees (normal 140), and left knee of 137 degrees.  The knees were without effusion.  Evidence of meniscus tear was absent, and clinical evidence of instability was not documented.  There was tenderness to palpation along the medial tibial plateaus, left greater than right.  The ankles had full active ROM without mechanical locking or resistance to pain.  There was mild tenderness to palpation along bilateral navicular foot bones.  The examiner noted a repeat bone scan showed evidence of resolving stress fractures.

At the 9 August 2011, VA Compensation and Pension evaluation, performed 38 months after separation, the CI reported her condition had improved and she had no treatment since discharge from service.  She had no functional limitation on standing, or walking.  Radiographs showed normal right and left tibia and fibula series.  Physical examination of the lower extremity was normal as well as ROM.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg condition at 20%, coded 5022 (periostitis) citing the US Army Physical Disability Agency pain policy, and noting that each leg was rated separately at 10% each.  The VA did not service-connect the condition.

The 5022 code rates the affected parts on limitation of motion; however, the condition was not compensable under the limitation of motion code, but painful motion was present during ROM testing, justifying the PEB’s 10% rating of each extremity.  Tests of ligament instability were both negative and positive; however, clinical usefulness was not established since there was no report of give way or instability.  Therefore, a higher rating under code 5257 (knee, other impairment of: recurrent subluxation or lateral instability) was not justified.  Code 5258 was not applicable since there were no objective evidence of frequent episodes of locking and effusions to support the use of that 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 bilateral leg condition.  

BOARD FINDINGS:  In the matter of the bilateral stress reactions of the tibia condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20150612, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009223, 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,					       
						      					
Enclosure