RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02537
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electronic Devices Repairer, medically separated for “bilateral lower extremity pain,” with a disability rating of 0%. 

CI CONTENTION:  The CI requested a review of all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20050711	VARD - 20061106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Extremity Pain…	5099-5003	0%	Stress Fracture, Left Lower Extremity	5299-5262	NSC	20060623	
			Stress Fracture, Right Lower Extremity 				
			Shin Splints, Left Lower Extremity 	5399-5312			
			Shin Splints, Right Lower Extremity 				
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Bilateral Lower Extremity (BLE) Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s BLE pain began in July 2003 shortly after training without specific injury or trauma.  Despite extensive conservative care to include profiles, physical therapy, nonsteroidal anti-inflammatory medications and rest, the CI continued to have pain with increased activity.  The MEB forwarded “bilateral shin splints” and “right tibia stress fracture” for PEB adjudication.  At a physical therapy clinic appointment on 27 June 2003, the CI complained of an insidious onset of lower extremity pain for 2 weeks duration.  She characterized the pain as strong and shooting.  Her pain level was a 7 out of 10.  Physical examination found tenderness and pain to palpation at the left distal tibia and medial tibial plateau.  The CI ambulated with an antalgic gait.  Radiographic studies showed a left medial tibial plateau and distal tibia stress reaction.  A telephonic consultation with the internal medicine department on 04 June 2004 referenced a bone scan report that showed “moderately severe bilateral shin splints with a small, healing stress fracture in the mid posteromedial right tibia.”  On 23 July 2003, the CI presented with complaints of left knee pain for 4 days duration.  The examiner noted tenderness to palpation over the area.  On 20 August 2003, the CI complained of foot pain for one month duration.  She stated that the pain was not due to any injury but came about when running.  On examination of the foot area, the right foot had positive point tenderness across the talar and acetabular area (dorsum of the foot), however there was “not any swelling.”  On 26 November 2003, the CI complained of right foot pain.  On 7 May 2004, the CI presented with complaints of shooting pains in her right shins for 1 week duration.  The CI was observed to limp with ambulation.  A bone scan performed on 24 May 2004 showed the CI had moderately severe bilateral shin splints with a small, healing stress fracture in the mid posteromedial right tibia and mild generalized stress reactions in both knee and ankle joints.  At a primary care appointment on 25 October 2004, 11 months prior to separation, the CI reported complaints of pain with running in her right tibia for approximately one month.  Physical examination found the pain was localized to the distal medial tibia and tender to palpation.  Radiographic findings evidenced old stress fractures without new callous formation.  At a primary care clinic appointment on 18 March 2005, 6 months prior to separation, the CI complained of left greater than right shin splints with pain ongoing for 6 months.  She stated that she had pain at rest and always with increased activity.  The CI further stated that the pain had progressed and increased in frequency.  Physical examination demonstrated tenderness to palpation to the distal medial tibias.  Radiographs of the tibias were negative.  The MEB NARSUM examination on 28 April 2005, 5 months prior to separation, noted complaints of chronic atraumatic bilateral lower extremity pain that began shortly after basic training.  The CI complained of pain with running, jumping, sit-ups, marching, prolonged standing greater than 15 minutes and the added weight of a flak vest and ruck sack.  Physical examination showed tenderness to palpation over the anteromedial aspect of the bilateral mid-tibia with a focal spot of pain at the distal metaphyseal junction of the right tibia.  Active range of motion (ROM) and sensation were noted to be normal. The examiner noted that the CI’s pain in the area was reproducible with resisted dorsiflexion.  At the 23 June 2006 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported that she developed stress fractures of the tibia while in basic training.  Physical exam showed pretibial regions were tender to palpation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral lower extremity pain condition under a single service disability rating of 0%, analogously coded 5099-5003 (degenerative arthritis), citing pain.  The VA did not service connect the BLE pain condition using analogous codes 5299-5262 and 5399-5312 (tibia and fibula impairment and group XII), based on the VA C&P examination 9 months after separation, citing no evidence of chronic condition caused by the service.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant with the 5003 combined rating criteria, each condition subsumed under the single Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. In this case, both lower extremities were profiled, considered to fail retention standards, and implicated by the NARSUM and in the commander’s statement.  The majority of the members agreed that each lower extremity was separately unfitting.  Multiple physical examination findings supported that reports of pain with use in both lower extremities.   Bone scan findings of the area showed “moderately severe bilateral shin splints with a small, healing stress fracture in the mid posteromedial right tibia.”  The NARSUM examination demonstrated the absence of limitation of motion at the ankle and knees.  The majority of the Board members agreed that the evidence supports a 10% combined rating for the bilateral leg pain condition under 5003.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the majority of the Board members recommend a disability rating of 10% for the bilateral lower extremity pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the bilateral lower extremity pain condition, the Board majority recommends a disability rating of 10% coded 5099-5003 IAW VASRD §4.71a.  The dissenting member recommended no change to the 0% rating and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	
Bilateral Lower Extremity Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

18 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004632 (PD-2015-02537)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA