RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02071
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Motor Transport Operator, medically separated for “left proximal tibial stress fracture” 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 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 - 20030331	VARD - 20031003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Proximal Tibial Stress Fracture 	5099-5003	0%	Residuals, Left Proximal Tibia Fracture	5262	10%	20030703	
Benign Bone Cyst Versus Fibrous Lesion	Not Unfitting	Benign Bone Cyst, Proximal Right Tibial Periarticular Region	7819	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Proximal Tibial Stress Fracture (Fx).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left stress fracture (fx) condition began in 2002 after experiencing pain while running at the advanced individual training course.  The CI was diagnosed with a left tibial stress fx and treated with activity modification and crutches.  He was placed on convalescent leave and then placed in the Physical Therapy Rehabilitation Unit.   The CI became asymptomatic following the rest and reported running two miles without pain.  He was returned to full duty; however, the left leg pain returned while running during a physical fitness test.  Left leg X-rays were unchanged from the previous visit.  
The 13 February 2003 MEB NARSUM examination, 2 months prior to separation, noted complaints of left leg pain graded 2/10 that increased to 5/10 with running.  Physical examination showed a slightly antalgic gait favoring the left.  There was no knee swelling or effusion.  Knee range of motion (ROM) was 0 degrees extension (normal 0) and 130 degrees flexion (normal 140) and ROM was limited by soft tissues.  There was a “mildly tender” palpable bony deformity over the proximal tibia in the area of the healing stress fx.  Ankle ROM was normal.  At the 3 July 2003 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported left leg pain with running or weight bearing activities.  Physical examination showed an antalgic gait favoring the left.  There was a bony prominence of the left anterior tibia and mild tenderness to palpation of the patellar region.  The CI was able to walk on heels and toes, but toe walking was painful and he could squat halfway.  Knee ROM was 0 degrees extension and 130 degrees flexion.  Ankle ROM was normal.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left proximal tibial stress fx condition 0%, with an analogous code 5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left proximal tibial stress fx condition 10%, coded 5262 (tibia and fibula impairment), based on the C&P examination 3 months after separation, citing tibial impairment with slight knee or ankle disability.  There was no evidence of painful motion of the knee or ankle joint with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) coded under 5003 or analogous to limitation of knee flexion (5260) or limitation of ankle motion (5271).  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of knee flexion or extension (5260, 5261) or 5271.  There was no history of dislocated meniscus or loose body causing frequent locking of the knee with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  

There was a stress fx of the tibia to support consideration under the code for knee or ankle impairment related to tibia and fibula impairment (5262).  The MEB NARSUM and VA examinations both noted the CI had an antalgic gait but there was no limited motion or painful motion of the either the knee or ankle documented.  Both the examinations noted knee flexion of 130 degrees and the VASRD normal for knee flexion is 140 degrees.  However, the MEB NARSUM examiner noted that the knee flexion was limited by the CI’s body habitus (soft tissues) and therefore 130 degrees flexion constituted full ROM for the CI.  No additional functional limitation was evidenced by the examinations.  Therefore the panel majority concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  The panel majority noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and a 0% rating under 5003 is complaint with the VASRD, therefore no change to the PEB’s code is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left proximal tibial stress fx condition.  

Contended PEB Conditions:  Benign bone cyst versus fibrous lesion.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended “benign bone cyst versus fibrous lesion” condition of the right leg was not unfitting.  During the work-up of the symptomatic left leg, a bone cyst or fibrous lesion of the right proximal tibia was incidentally noted on imaging.  The contended condition was not profiled or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left proximal tibial stress fracture condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  In the matter of the contended benign bone cyst versus fibrous lesion condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 20150726, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009991, 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,