RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02477
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20030502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Seaman Recruit, medically separated for “right tibial diaphyseal stress reaction” with a disability rating of 10%.  

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 - 20030502	VARD – 20030709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
R Tibial…Stress Reaction	5022-5003	10%	R Tibial Stress Changes	5299-5262	NSC	20030409	
L…Femoral…Stress Change…	Cat II	L Femoral Stress Changes	5299-5255			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: NSC	

ANALYSIS SUMMARY:  

Right Tibial Diaphyseal Stress Reaction.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right tibial stress reaction began in October 2002 shortly after starting Recruit Training.  Earliest symptoms were right lower extremity pain, with progression to right hip and left hip pain.  X-rays were normal and bone scans showed left hip stress reaction versus stress fracture and right tibial stress changes.  

The 6 March 2003 MEB NARSUM examination, 2 months prior to separation, was for the PEB-listed diagnoses.  Physical examination showed intact gait including heel, toe, and tandem.  Both hips had full range of motion (ROM) with negative testing for pain on provocative movements (FABER).  Both knees had ROM of 0-130 degrees (normal 0-140) without tenderness, laxity or instability.  There was tenderness on the right medial tibial plateau and medial femoral condyle.  Bilateral ankle ROMs were plantar flexion of 40 degrees (normal 45) and dorsiflexion of 20 degrees (normal).  There was no ankle instability or laxity.  Muscle strength and reflexes were normal and the lower extremities were neurovascularly intact.  During 10 March 2003 MEB examination (recorded on Standard Forms 93 and 88), the CI reported painful joints and foot trouble due to stress fractures in left distal femur, bilateral tibia, and right foot.  Physical examination showed tenderness over the shins bilaterally.  

At the 9 April 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported pain from the right knee to the ankle, with minimal left leg pain, and took pain medication once a day.  Physical examination showed the CI walked easily.  Examination of the feet and ankles were normal with full painless ROM.  There was tenderness over the right mid tibia and medial tibial plateau.  The knees and hips had full painless ROM without laxity or instability.  There was no lower extremity muscle atrophy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right tibial diaphyseal stress reaction 10%, coded 5022-5003 (periostitis – degenerative arthritis).  The VA categorized the right tibial stress changes using a 5299-5262 code (analogous to impairment of the tibia and fibula) as not service connected (not rated), based on the C&P examination 1 month before separation, citing no actual disability.  The right tibia was tender and there was no painful motion of the right knee or ankle.  There was less ROM of the knee and ankle, but ROMs were symmetric with the opposite paired joint.  There was no evidence that the CI had greater than slight knee or ankle disability for any rating higher than 10% under code 5262.  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  

The PEB listed the “left distal femoral metaphyseal stress change versus early stress fracture” condition as a Category II condition, a condition that is related to the primary unfitting condition and contributes to the primary unfitting condition.  The panel’s first charge for this Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  

The left femoral stress changes developed during the same timeframe as the right tibial stress reaction and may have been related to increased stresses due to the right leg condition.  The non-medical assessment (NMA) specifically noted the duty/training limitations of the condition and it was forwarded as a separate condition by the MEB.  The NARSUM noted the CI’s history of multiple stress fractures limited the CI’s performance.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the category II left femur condition was reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting left femur condition at the time of separation.  

The examinations of the left femur condition were detailed above.  There was no left femur tenderness or objective findings of painful or limited motion of the left hip.  The left knee had painless ROM symmetric to the opposite knee.  The VA categorized the left femoral stress changes using a 5299-5255 code (analogous to impairment of the femur) as not service connected (not rated), based on the C&P examination 1 month before separation, citing no actual disability.  The panel adjudged that there was no compensable limitation or painful motion of the left hip or left knee and that the CI’s left femur condition disability picture at separation was did not meet the 10% rating criteria under code 5255 (impairment of the femur).  Therefore, separating out the left femur condition would provide no benefit to the CI.  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 right tibia and left femur condition.  

BOARD FINDINGS:  In the matter of the right tibia condition with Category II left femur condition, and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20151018, 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
							XXXXXXXXXXXXXXXXXXX
	     				Principal Deputy, Assistant 
						Secretary of the Navy
						(Manpower and Reserve Affairs)
						Performing the Duties of the 
						Assistant Secretary of the Navy
						              (Manpower and Reserve Affairs)