RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02370
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Armament, Electrical, Avionics Systems Repairer, medically separated for “chronic anterior tibial pain bilaterally without evidence of stress fracture” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20060530	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Anterior Tibial Pain Bilaterally 	5022	0%	No VA Exam In Evidence	

ANALYSIS SUMMARY:    

Anterior Tibia Pain, Bilateral.  The PEB combined the bilateral tibial pain conditions as a single unfitting condition coded 5022 (periostitis) and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  VA code 5022 utilizes VA code 5003 rating criteria.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral leg pain began in during Basic training and the pain increased during Advanced Individual Training.  Symptoms increased with running and jumping activities and did not respond to non-steroidal anti-inflammatory drug, rest or profiling.  On 6 April 2005 a bone scan was positive for bilateral shin splints and no evidence of stress fractures.  On 24 October 2005 bilateral tibial and fibula X-rays were normal.  At the 2 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI did not complain of shin pain.  The CI only reported complaints of foot and ankle pain and use of arch supports.  Physical examination showed bilateral anterior tibia tenderness to palpation.  The 11 May 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of bilateral foot, ankle and leg pain.  Physical examination showed pain to palpation across the anterior midfoot, right greater than left across the tarsal joints.  Range of motion (ROM) was recorded as ankle joint greater than 10 degrees of dorsiflexion, greater than 35 degrees of plantar flexion.  There was no crepitus with ROM.  The CI did not file a claim for disability with the VA.  

The panel first considered if the left and right leg anterior tibia pain conditions having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel noted that the recurrent bilateral leg pain was activity related pain, associated with no numbness/tingling of the toes, with no fixed sensory or motor deficits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral anterior tibial pain 0%, coded 5022 (periostitis).  There was no VA C&P examination for consideration.  

The Board carefully considered the option of rating both tibia together versus each leg separately.  Members concluded that the evidence did provide sufficient grounds for recommending separate leg disability ratings and that a rating of 10% for the right and 10% for the left, coded 5099-5262, is a good analogy to both the pathology and disability.  The panel noted a mild right antalgic gait with bilateral anterior tibia tenderness with the CI reporting an inability to stand for greater than 45 minutes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right tibial pain condition, and 10% for the left tibial pain condition, each analogously coded 5299-5262.

BOARD FINDINGS:  In the matter of the right tibial pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5262 IAW VASRD §4.59.  In the matter of the left tibial pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5262 IAW VASRD §4.59.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Leg Pain	5299-5262	10%	
Left Leg Pain	5299-5262	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012618, XXXXXXXXXXXXXXXXXXL.

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure