RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02372
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060730

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Quartermaster, medically separated for “chronic bilateral recurring tibial stress fractures…” rating each tibia 10%, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends for her unfitting bilateral tibial stress fractures, her Category III bilateral wrist pain and conditions not identified by either the MEB or PEB.  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 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 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 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 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 - 20060605	VARD - 20081006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Recurring Tibial Stress Fractures…	5003-5262	20%	Stress Fractures (Recurring), Right Tibia	5299-5262	NSC	STR	
			Stress Fractures (Recurring), Left Tibia	5299-5262	NSC	STR	
Chronic Wrist Pain	Cat III	Arthralgia, Right Wrist	5099-5003	NSC	STR	
		Arthralgia, Left Wrist	5099-5003	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Bilateral Recurring Tibial Stress Fractures.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral recurring tibial stress fractures condition began in December 2003 with no specific trauma or injury.  At the 18 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported a 6 year history of bilateral wrist pain with swelling due to arthritis.  Physical examination showed bilateral wrists had decreased range of motion (ROM), intact sensation and normal 5/5 strength.  The CI’s lower extremities were listed as normal.  The 17 April 2006 MEB NARSUM examination, 3 months prior to separation, noted no specific complaints.  Physical examination of her bilateral lower extremities showed some mild tenderness along the posterior medial aspect of the proximal third of the tibia. She had 5/5 strength.  Her bilateral wrists showed mild edema in the wrist area with positive tenderness.  She had a minimally positive test for de Quervain's tenosynovitis (thumb tendonitis) bilaterally.  The record did not show that the CI attended a VA Compensation and Pension (C&P) evaluation proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral recurring tibial stress fractures condition 20% (10% for each tibia), dual coded 5003-5262 (degenerative arthritis and impairment of tibia and fibula).  The VA did not service connect the chronic bilateral recurring tibial stress fractures using code 5299-5262 (impairment of tibia and fibula), based on the STR, citing not enough evidence that the claimed condition still existed.  The panel agreed that a 10% (slight) rating was appropriate for the right and left leg conditions and a moderate rating of 20% was not justified.  IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss) and §4.59 (Painful motion), when part of the musculoskeletal system becomes painful with use it must be considered disabled.  A disability rating of 10% is warranted when there is satisfactory evidence of functional loss and functional impairment due to pain.  The panel determined that a disability rating of 10% for each leg was appropriate.  However panel members agreed that the recurring tibial stress fractures, and painful motion were related diagnoses and were not separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  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 recurring bilateral tibial stress fractures condition.  

Contended PEB Conditions: Bilateral Wrist Pain:  The panel’s main charge is to assess the fairness of the PEB’s determination that chronic bilateral wrist pain was not unfitting.  The CI had been placed on limited duty two times for the chronic wrist pain, and was judged to fail retention standards for the condition; however the condition was not specifically implicated in the commander’s statement.  Furthermore, although there was performance-based evidence from the record (she was limited to administrative duty) that the condition required some duty modification, there was not a preponderance of evidence to show the bilateral wrist pain was separately unfit.  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.  

PANEL FINDINGS:  In the matter of the bilateral recurring tibial stress fractures condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended right and left wrist conditions, the panel unanimously recommends no change from the PEB determinations 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150830, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting