RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01876
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090609  

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

CI CONTENTION:  The CI made no specific contention.  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 - 20090522	VARD - 20100420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Medial Tibial Plateau Stress Fractures	5299-5262	10% + 10% 	Residuals of Right Tibial Stress Fracture	5262	NSC	20100216	
			Residuals of Left Tibial Stress Fracture	5262	NSC	20100216	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Medial Tibial Plateau Stress Fractures.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic bilateral leg pain condition began in January 2009 while in training.  She was diagnosed with bilateral tibial stress fractures (confirmed by X-rays) and convalescent leave and conservative therapy did not progress to allow return to training.  There was no surgical indication.  

At the 13 April 2009 Physical Therapy (PT) MEB range of motion (ROM) evaluation, performed 2 months prior to separation, the right knee had pain limited flexion to 115 degrees (normal 140) following repetition with 0 degrees (normal) extension.  The left knee had pain limited flexion to 110 degrees (normal 140) following repetition with 0 degrees (normal) extension.  Both ankles had painful motion to normal limits after repetition.  

The MEB NARSUM examination on 20 April 2009, 2 months prior to separation, noted complaints of bilateral knee/leg pain.  Physical examination showed a normal gait.  There was tenderness to the bilateral tibia plateaus.  Leg compartments were soft and muscle, reflex and neurovascular testing were normal.  ROM of both knees was flexion to 135 degrees (normal 140) and extension to 0 degrees (normal).  Both knees were stable with no asymmetric laxity.  Both ankles demonstrated normal ROM with no tenderness around the ankles or Achilles tendons.  Repeat X-rays from 7 April 2009 showed signs of healing in the tibias consistent with stress fractures.  

At the 16 February 2010 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported lower leg pain after standing more than 20 minutes or long walks.  Physical examination showed a normal gait.  There was no tibial tenderness, swelling, edema, discoloration, or deformities.  Motor, reflex, and sensation testing were normal.  The physician’s diagnosis was “bilateral tibia, status-post stress fracture, healed.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral medial tibial plateau stress fractures condition 20% (10% for the left knee and 10% for the right knee), coded 5299-5262 (tibia and fibula, impairment), citing slight knee disability.  The VA rated the left and right residuals of tibial stress fracture conditions each as not service connected (NSC) coded 5262, based on the C&P examination 8 months after separation, citing healed tibial stress fractures with no permanent residual or chronic disability.  

There was a history of stress fracture of each tibia to support consideration under code 5262 for impairment related to long bone conditions (5262).  The panel deliberated if there were greater than “slight knee or ankle disability” for any rating higher than the 10% for each leg adjudicated by the PEB.  There was no ankle limitation of motion or evidence of ankle disability for either leg at the NARSUM.  Painful ankle motion noted at the PT evaluation.  Both knee ROMs were slightly limited without objective evidence of painful motion at the NARSUM, with painful knee motion noted at the PT evaluation.  There was no limitation of knee motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The panel adjudged that there was insufficient evidence that either the left or the right lower leg rose to the level of “moderate knee or ankle disability” to warrant any rating higher than the 10% adjudicated by the PEB.  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 medial tibial plateau stress fractures condition.  

BOARD FINDINGS:  In the matter of the bilateral medial tibial plateau stress fractures condition and IAW VASRD §4.71a, the panel unanimously 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 20150624, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009233, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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