RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01904
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, M2/3 Bradley Fighting Vehicle System Maintainer, medically separated for “bilateral lower extremity stress reactions,” 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 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.  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 determinations 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 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 – 20050801	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Stress Reactions	5022	0%	S/P Stress Fractures; LLE	5299-5262	10%	STR	
			S/P Stress Fractures; RLE	5299-5262	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

Bilateral Lower Extremity Stress Reactions.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral stress reactions began in March 2005 during basic training.   

The 7 July 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of pain with walking and inability to complete basic training.  The CI indicated he had a moderate amount of pain occasionally.  Physical examination showed full active range of motion (ROM) of his knees and ankles with pain.  He was tender on the inside of his knees, over the shins, and the ankles bilaterally.  There was no bruising, swelling or redness, but an an antalgic gait was noted.  Orthopedics diagnosed bilateral lower extremity stress fractures unrelieved with conservative treatment.  The VA did not perform a Compensation and Pension (C&P) evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral lower extremity stress reactions condition 0%, coded 5022 (periostitis), citing leg pain without significant loss of joint motion.  The VA rated the left and right lower extremity stress fractures separately at 10% each, coded 5299-5262 (analogous to impairment of the tibia and fibula), based on the STR, citing bilateral painful motion of the knee and ankle.  

In this case, evidence indicated the right and left lower extremity were equally symptomatic, both were profiled and coded L3.  Examination findings were essentially the same in both, with evidence of stress fractures of the right and left legs and the right ankle.   There was tenderness of both ankles. Examinations did not document range of motion (ROM), therefore there was no compensable ROM.  Radiographic studies documented bilateral pathology and the MEB NARSUM documented painful motion of each leg.  According to IAW VASRD §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Although conservative treatment had been provided, there was persistent pain in both the right and left extremity that interfered with work and were individually unfitting. The panel unanimously agreed that separate disability ratings of 10% each were warranted for the right and the left leg conditions.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right lower extremity stress reaction, coded 5022, and a separate 10% rating for the left lower extremity stress reaction, also coded 5022.  

BOARD FINDINGS:  In the matter of the right lower extremity stress reactions condition, the panel unanimously recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  In the matter of the left lower extremity stress reactions condition, the panel unanimously recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Lower Extremity Stress Reactions	5022	10%	
Left Lower Extremity Stress Reactions	5022	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009275, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure