RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00283
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “bilateral shin splints,” with a disability rating of 0%.

CI CONTENTION:  The CI’s contends his conditions continue to worsen.  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 - 20021226	VARD – 20040221 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints	5022	0%	Stress Periostitis with Stress Fracture of the Left Lower Extremity	5022-5262	10%	20040110	
			Periostitis of the Right Lower Leg	5022-5262	10%		
Chronic Low Back Pain	Not Unfitting	Degenerative Disk Disease, L4-5	5293	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Shin Splints.  The PEB combined the left and right shin splints conditions under a single disability rating, coded 5022 (periostitis).  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the left and right shin splints conditions are presented below, with attendant recommendations regarding separate unfitness, and separate rating if indicated. 

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral shin splints condition began in 1999 during basic training.  The CI eventually developed a full stress fracture of the proximal left tibia.  Despite multiple prolonged periods of duty restrictions and relative rest, bilateral shin pain, left greater than right, would return with a return to normal activity levels.  A bone scan in 21 August 2002 showed multiple areas of increased uptake consistent with stress reactions and a likely slow healing stress fracture of the left tibia.  The 26 August 2002 commander’s statement, 7 months before separation, did not specifically identify the medical conditions that limited the CI’s duty performance, but noted that the CI’s physical profile lifting and carrying restrictions impaired successful performance of the duties of her MOS.  The 27 April 2002 permanent profile, 7 months before separation, listed bilateral shin splints.  

The 27 August 2002 MEB examination (recorded on DD Forms 2807 and 2808) and the VA Compensation and Pension (C&P) examination were both completed by the same examiner on the same day.  Please refer to the following VA C&P examination summary.  At the 27 August 2002 VA (C&P) evaluation, performed 7 months before separation, the CI reported bilateral anterior leg pain, with constant left leg pain with swelling and occasional right leg pain.  The pain was aggravated by prolonged walking or running and improved with rest, elevation and ice.  Physical examination showed normal posture and gait.  There was tenderness to palpation of both anterior lower legs with marked TTP over the proximal left tibia with swelling.  There was normal knee and ankle range of motion.  Muscle strength was normal throughout.  The 18 November 2002 MEB NARSUM examination, 5 months prior to separation, noted complaints of bilateral shin pain.  Physical examination showed TTP of both anterior lower legs, left greater than right.  Ankle and knee ROM was symmetric bilaterally and the examiner noted there was no restriction of motion of any joint.  Imaging, including X-rays and computed tomography, was noted to show progressive healing of the stress fracture.  The MEB NARSUM examiner determined the bilateral shin splints conditions were medically unacceptable.  At the 10 January 2004 VA (C&P) evaluation, 9 months after separation, the CI reported bilateral LE pain, left greater than right.  Physical examination noted TTP of the bilateral anterior lower legs, greatest of the left proximal tibia.  Bilateral tibia/fibula X-rays again showed the findings consistent with a stress fracture of the proximal left tibia.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the left and right shin splint conditions as noted above and rated 0%, coded 5022 (Periostitis), citing normal range of motion.  The VA rated the “stress periostitis with stress fracture of the left lower extremity” 10% and “periostitis of the right lower leg” conditions 0%, coded 5022-5262 (periostitis - tibia and fibula, impairment of), based on the VA C&P examination 7 months before separation, citing pain, tenderness and swelling of the left leg.  The 21 February 2004 VARD continued the 10% rating of the left leg and increased the rating of the right leg to 10%, based on the VA C&P examination, 9 months after separation, citing pain and tenderness of both legs.  The panel first considered if the left and right shin splints conditions, having been de-coupled from the combined PEB adjudication, each remained separately unfitting as established above.  The bilateral shin splints conditions were permanently profiled, implicated by the commander’s statement and determined by the MEB to be medically unacceptable.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that both the left and right shin splints condition were reasonably considered separately unfitting.  The relevant clinical information for rating is identical for both lower extremities.  Therefore the rating of the left and right shin splints conditions will be discussed together.  There was no evidence of painful limited motion of either knee or ankle with imaging evidence of pathology for 10% rating under 5022 or coded as 5299-5260 (limitation of leg flexion) or 5299-5271 (limitation of ankle motion), based on §4.59, §4.40 and §4.45.  There was likewise no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of knee flexion or extension (5260, 5261) or limitation of ankle motion (5271) for either lower extremity.  There was therefore no higher rating than 0% available for the left shin splints lower extremity stress fracture condition under any applicable VASRD code.  The left tibial stress fracture appeared to be healing slowly, but as noted above there was no evidence of knee or ankle disability or nonunion requiring a brace for consideration of rating under 5262.  After unbundling the left and right shin splints, no higher rating than 0% was supported for either condition and unbundling provided no ratings benefit to the CI.  Therefore, no change to the PEB’s combined adjudication is recommended.  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 shin splints condition.  

Contended PEB Conditions:  Chronic Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  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.  

BOARD FINDINGS:  In the matter of the bilateral shin splints condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic low back pain condition, the panel unanimously recommends no change from the PEB determination 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170014151, 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