RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01928
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Advanced Individual Trainee, medically separated for “bilateral tibial stress fractures,” with a combined disability rating of 0%.  

CI CONTENTION: The CI made no specific contention.  The 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 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 - 20040607	VARD - 20041126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Stress Fractures	5022	0%	Status Post, Shin-Splint, Right Lower Extremity	5299-5262	0%	20040818	
			Status Post, Shin-Splint, Left Lower Extremity	5299-5262	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Tibial Stress Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral tibial stress fractures began during basic training and became intolerable in January 2004 during advanced individual training (AIT).  The CI had severe pain in the shins and could not progress through training.  Initial X-rays in May 2003 were normal and a bone scan in June 2003 showed bilateral tibial stress fractures.  Follow-up X-rays in January 2004 showed a healing stress fracture in the right tibia and a normal left leg study.  However, the CI continued to have bilateral leg pain.  Physical therapy treatment notes through February 2004 documented normal gait, normal gross joint range of motions (ROM) and normal gross muscle strength.  There was a consistent finding of tenderness to palpation of the bilateral shins.  Despite treatment of the bilateral tibial stress fractures condition the CI was unable to perform soldiering activities and he was referred for an MEB.  The MEB forwarded “bilateral tribal stress fractures” for PEB adjudication.  The MEB NARSUM examination on 24 March 2004, 4 months prior to separation, noted complaints of bilateral leg pain.  He was not able to perform exercises because of the pain in his shins.  Physical examination showed bilateral tenderness over the shins with the right worse than the left.  The legs were neurovascularly intact.  Bilateral shin tenderness was confirmed at the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2004, 3 months prior to separation.  

At the 18 August 2004 VA Compensation and Pension (C&P) evaluation, performed 10 days after separation, the CI reported pain in the anterior medial aspect of both lower extremities that was diagnosed as stress fractures and persisted.  Physical examination showed complaints of tenderness to palpation of the anterior medial aspect of both lower legs, “consistent with shin splints.”  Lower extremity reflexes and muscle strength were normal.  ROM of both knees and ankles were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral tibial stress fractures 0%, coded 5022 (periostitis), citing the fractures were not confirmed by X-ray and did not result in limitation of motion.  The VA rated the right and left tibial stress fractures 0% each respectively, coded 5262 (tibia and fibula, impairment of), based on the VA C&P examination 10 days after separation, citing the “absence of malunion of the tibia and fibula with slight knee or ankle disability.”  There was no evidence of nonunion or malunion of the left or right tibia, and no evidence of any ankle or knee disability in any exam proximate to separation.  Although the ideal coding would be a separated 0% for the left and 0% for the right under either code 5022 or code 5262, there would be no change in the 0% combined disability rating awarded by the PEB, and no benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral tibial stress fractures.  

BOARD FINDINGS:  In the matter of the bilateral tibial stress fractures condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXX.

XXXXXXXXXXXXXXXXXX
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,