RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01916
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Basic Trainee, medically separated for “chronic pain status post healing of left distal tibia-fibula fracture” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20071030	VARD - 20111214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Status Post Healing of Left Distal Tibia-Fibula Fracture	5099-5003	10%	Left Leg Fracture, Tibia and Fibula	5262	10%	20111130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain Status Post Healing of Left Distal Tibia-Fibula Fracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower left leg pain began in July 2007 after falling in a 20- to 50-foot deep ravine during basic training.  The CI was surgically treated for a fracture of the distal tibia and fibula with intramedullary nailing.  

The 13 August 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of diffuse, achy anterior knee pain that occasionally radiated medially and increased with plantar flexion of the foot and toes.  The physical examination showed active and passive range of motion (ROM) of the knee was normal and the patellofemoral joint had normal tracking.  There was diffuse tenderness along the medial para patellar reticulum with some tenderness along the anterior medial joint line and the insertion of the patella ligament.  There were no knee effusions.  

There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lower left leg pain 10%, coded 5003 (arthritis, degenerative (hypertrophic or osteoarthritis)), citing the US Army Physical Disability Agency pain policy.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The persistence of pain after nailing of the leg fracture warranted a 10% rating under the 5099-5003 code (analogous to degenerative arthritis) as adjudicated by the PEB.  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 those respective codes.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability. 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the lower left leg pain.  

BOARD FINDINGS:  In the matter of the chronic pain status post healing of left distal tibia-fibula fracture pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20150713, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170008812, 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,