RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02267
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050824

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 “left lower leg pain,” with a disability rating of 0%.

CI CONTENTION:  The CI request 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 - 20050810	VARD - 20060522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Lower Leg Pain	5022	0%	PFS…	5255-5262	10%	20060127	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Lower Leg Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left lower leg pain condition began in March 2005.  She was initially seen for left thigh and then left ankle pain.  X-rays of the latter were normal.  Her symptoms persisted and a stress fracture was suspected.  Repeat ankle X-rays on 6 April 2005 were normal.  A bone scan 2 days later showed a stress fracture of the left distal tibia (shin bone near the ankle) and stress changes of both femurs, knees, and shin bones (tibial shafts).  She was issued crutches and placed on limited duty.  A repeat X-ray on 25 April 2005 showed the stress fracture of the left distal tibia.  A repeat bone scan on 2 May 2005 showed the left tibia stress fracture and increased uptake in the left foot.  No comment was made on the femurs, knees, or tibial shafts which previously had shown stress changes.  In physical therapy on 13 may 2005, the CI had normal movement of all extremities.  The ankle was tender to palpation.  X-rays of the left ankle and the pelvis that day were normal.  X-rays of both lower legs on 3 June 2005 were also normal.  In physical therapy on 3 June 2005, the CI was noted to have normal movement of the lower extremities and a normal gait.  Dorsiflexion and eversion were painful though.  Both ankles were tender to touch.  It was noted that her motivation for return to duty was poor and consideration for an MEB was recommended.  

During the 7 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported knee pain while walking.  Tenderness over the distal tibiae, left > right, was noted on examination.  In physical therapy on 24 June 2005, the CI reported ongoing pain despite 15 weeks of limited duty.  A formal examination was deferred at the CI’s request, but it was observed that she had normal ambulation and position transfers (sit to stand) without evidence of pain or stiffness.  

At the 14 July 2005 MEB NARSUM examination, 1 month prior to separation the CI reported persistent lower leg pain aggravated by prolonged walking and standing.  However, the clinical note dated the same day noted that she was pain free.  The examination referred to the DD 2808, but was more detailed.  The gait was normal.  The knees had normal range of motion without localized tenderness or signs of instability.  Localized tenderness was present over the left distal tibia, but the range of motion was full.  Painful motion was not recorded.  There was no swelling or redness (erythema) and motor function was normal.  She reported that she wanted to go home to heal and then re-enlist at a later date.  

At the 27 January 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported that she fell and injured her left ankle while on an obstacle course during basic training.  She reported weakness and pain of the left ankle which was aggravated by activity.  On examination, dorsiflexion (toes up) was reduced to 15 degrees (normal is 20) and plantar flexion (toes down) was reduced to 35 degrees (normal is 45).  Painful motion was not recorded.  The right ankle was normal.  There was no redness, swelling, tenderness, or deformities of the left ankle.  The gait was normal as was the range of motion for the knees.  X-rays of the knees and ankles were normal.  The left tibial fracture was thought to be healed with residual limitation in motion and restriction of function.  A VA C&P examination for the spine, dated 18 September 2007, over 2 years after separation, noted a normal gait and range of motion for the left ankle.  The panel noted that an examination over 12 months after separation is normally not probative for rating at separation.  In this case, the VA C&P proximate showed a limitation in motion not seen on the examinations (above) prior to and more proximate to separation.  This later VA C&P served to bracket the initial VA C&P examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left lower leg pain condition 0%, coded 5022 (periostitis), citing extensive profile restrictions and continued pain.  The VA rated the “patellofemoral pain syndrome with stress changes of the femur and tibia, status post distal tibial stress fracture” condition 10% coded 5255-5262 (femur, impairment of; analogous to tibia and fibula, impairment of), based on the VA C&P examination 5 months after separation, citing the VA exam showing subjective reporting of weakness of the left ankle joint and left knee joint and continued intermittent pain of the left lower part of the left tibia and left knee.  The panel considered the evidence.  A stress fracture of the distal left tibia was shown on both bone scan and an X-ray.  Subsequent X-rays were normal though, consistent with healing which is expected with the treatment received (limited weight bearing and rest).  A slight limitation in motion was recorded on the VA C&P examination 5 months post-separation.  Motion was noted to be normal at a physical therapy examination 2 months prior to separation and at the NARSUM evaluation 1 month prior to separation.  Also, a VA examination for the spine documented normal motion of the ankle 24 months after separation.  The VA examination proximate to separation was determined to be an outlier and not used for rating purposes.  Painful motion was documented on the physical therapy examination 2 months prior to separation, but not on either the NARSUM or VA C&P examinations.  The panel also noted the comments by the physical therapist 1 month prior to separation that the CI appeared to have no pain or stiffness with movement.  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 left lower leg pain condition.  

BOARD FINDINGS:  In the matter of the left lower leg pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150718, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012164, 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,