RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00074
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030421

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 tibial shaft stress fracture” with a disability rating of 0%.

CI CONTENTION:  “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 - 20030404	VARD - 20030424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Tibial Shaft Stress Fracture…	5009-5003	0%	Left Tibial Stress Fracture	5099-5014	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Tibial Shaft Stress Diagnosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left tibia stress fracture condition began in July 2001, one month after beginning basic training.  No trauma or injury was reported.  The CI was placed on convalescent leave for two weeks; however, the pain did not improve.  Bone scan studies 13 August 2003 showed stress fractures of the left mid-shaft of the tibia and bilateral feet.  After a second period of convalescent leave the left tibia was the only remaining area of pain.  X-ray studies performed 3 December 2002 were normal.  While attempting to gradually increase his running, the CI again reported left leg pain with a “limp” developing at the end of a one-fourth mile run.  Despite additional treatment, the CI’s left leg pain could not be rehabilitated to meet the physical requirements to complete basic training.  

The 14 March 2003 MEB NARSUM examination, 1 month prior to separation, noted complaints of left lower leg pain with any increase in activity.  Physical examination showed tenderness with palpation over the mid-shaft of the left tibia.  

At the 10 September 2003 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI complained of mid-shaft left tibial pain with increased activity and tenderness over the area.  Physical examination showed a normal gait with tenderness to palpation over the mid-shaft of the left tibia.  Plain film x-rays of the left tibia and fibula were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left tibial stress fracture condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left tibial stress fracture condition 10% coded 5099-5014 (analogous to osteomalacia), based on the STR and the C&P evaluation, 5 months after separation, citing continued findings of painful functional impairment with activities and tenderness over the mid-shaft of the left tibia.  

There was no evidence of nonunion or malunion of the tibia with any degree of knee or ankle disability to justify any rating under code 5262 (tibia and fibula, impairment of).  There was no evidence of limited ROM of the knee or ankle or evidence of painful motion to rate under any of the respective codes.  Antalgic gait was not recorded on any examination proximate to separation to provide evidence of painful motion with functional loss supporting a minimum 10% rating (based on §4.59, §4.40 and §4.45).   

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left tibia stress fracture condition.  

BOARD FINDINGS:  In the matter of the left tibia stress fracture 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 20160630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013281, 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,					      
						      					
Enclosure