RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01927
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic pain due to right tibial stress fractures” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20040425	VARD - 20050726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain due to Right Tibial Stress Fractures	5099-5003	10%	Status Post Right Tibial Stress Fracture	5299-5262	0%	20050407	
			Anterior Compartment Stress Reaction, Right Leg	5399-5312	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain due to Right Tibial Stress Fractures.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right lower leg pain began in July 2004 without specific injury or trauma in basic training.  X-rays showed right tibial stress fracture.  There was no surgical indication.  

The MEB NARSUM examination on 3 March 2005, 3 months prior to separation, noted complaints of pain in the lower right leg that hurt (4-6/10) 50% of the time and was aggravated by use of boots, running or walking any prolonged distance.  Physical examination showed a normal gait.  There was pain to palpation along the right anterior tibial edge from 3 inches below the knee to 3 inches above the ankle.  There was no palpable irregularity of the bone in this area.  There was “unrestricted ranges of motion of his lower extremities bilaterally.”  

At the 7 April 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported constant right leg pain and difficulty running for an extended period.  Physical examination showed a normal gait with normal right tibia and fibula finding and normal strength.  There were no muscle injury residuals noted.  The right knee and ankle had full painless range of motion without additional limitations on repetition.  Right tibia and fibula X-ray was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain condition 10%, analogously coded 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right lower leg pain condition as “status post right tibial stress fracture” at 0% analogously coded 5262 (tibia/fibula impairment), citing X-ray findings within normal limits; and also rated right leg anterior compartment stress reaction at 0% analogously coded 5312 (group XII, muscle), citing persistent pain with certain activities; both based on the C&P examination 1 month after separation.  

There was tenderness to palpation over the right tibia with no evidence of right knee or ankle joint decreased motion or painful motion.  Since there was no evidence of joint degenerative changes or painful motion of a joint, VASRD-only rating would be analogous to 5262 (tibia/fibula impairment).  There was insufficient evidence that the CI’s disability rose to the level of “moderate knee or ankle disability” for any rating higher than the 10% awarded 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 chronic pain condition.  

BOARD FINDINGS:  In the matter of the chronic pain condition 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 20150615, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014662 XXXXXXXXXXXXXXXXXX,. 

XXXXXXXXXXXXXXXXXX

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