RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2016-00274
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061103

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cyber Network Defender, medically separated for “chronic bilateral tibial stress reactions” with a disability rating of 10%.

CI CONTENTION:	The  CI  contends  that  the  VA  rated  his condition higher.	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 - 20060712	VARD - 20070205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Tibial Stress Reactions	5099-5022	10%	Left Tibial Stress Reaction…	5099-5022	0%	20020060918	
			Right Tibial Stress Reaction…	5099-5022	0%	20020060918	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Bilateral Tibial Stress Reactions. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the first record in evidence for the bilateral leg condition is an X-ray report dated 22 August 2005 which recorded a 2-month history of bilateral anteromedial tibial (shin) pain which was worsening especially after running. On bone scan, dated 18 November 2005, bilateral stress changes without fracture were seen. In physical therapy on 11 January 2006, the gait was non-antalgic (normal) and the squat normal. Bilateral shin tenderness was present, but the examination was otherwise normal.
The 1 June 2006 MEB NARSUM examination, 5 months prior to separation, referenced the physical examination documented on the DD Form 2808 the previous day. It noted that a follow up bone scan on 29 March 2006 showed persistent stress changes, but interval improvement from the prior scan. The CI reported minimal improvement with treatment and persistent aggravation of symptoms from increased activity. Tenderness over both shins was present on examination.

At the 18 September 2006 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported pain which radiated to his hips and feet and limited walking to half a mile. On examination, the 70 inch tall CI was noted to weigh 225 pounds. The gait and posture were normal. The shins (tibiae), knees, and ankles were normal to examination including range of motion.  X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic bilateral tibial stress reactions at 10%, coded 5099-5022 (analogous to periostitis), citing tenderness. The VA separately rated each shin 0%, also coded 5099-5022, based on the C&P examination 2 months prior to separation. Incapacitation was not reported. The panel first considered if the bilateral shin splints were separately unfitting. Both were found to fail retention standards by the MEB and both were cited by the commander. The evidence supported a determination that each shin was separately unfitting. The panel then considered the ratings. Bone scans were positive, but improving as were the clinical symptoms at the time of the NARSUM. The C&P examination was normal. The panel also noted that the clinical examination and X-rays of knees and ankles were normal. The evidence does not support a compensable rating at separation for either shin, separately or combined. However, the panel does not recommend a rating lower than that adjudicated by the PEB. 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 bilateral tibial stress condition.

BOARD FINDINGS:  In the matter of the chronic bilateral tibial stress reactions and   IAW VASRD
§4.71a, the panel unanimously recommends no change in the PEB adjudication. There were 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.

AR20190011839, 

Dear XXXXXXXXXXXXXXXXXXXXX:

	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.

A copy of this decision has been provided to the counsel you listed on your application.

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