RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00577
BRANCH OF SERVICE:  ArMY	SEPARATION DATE:  20040621

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

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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040503	VARD - 20041104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lower Extremity Pain	5099-5003	0%	Painful Residuals from Stress Fracture, Right Tibia	5262	10%	20040902	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

RLE Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s RLE condition began in March 2003 after he sustained a stress fracture of the tibia while running.  X-rays confirmed a right tibial stress fracture.  After a year of treatment, he still had significant pain.  The 7 April 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of right leg pain greater than one year.  He was unable to climb up and down vehicles, which limited his work as a mechanic.  He was unable to run or do any prolonged standing or physical exertion.  He could not play any sports and occasionally had numbness and tingling in his foot.  He past his last physical fitness test on 8 March 2003.  He reported that his pain escalated with increased activity or standing for long periods.  X-rays taken on 23 January 2004, revealed a persistent stress fracture.  Physical examination of the RLE showed full symmetrical range of motion (ROM) of the knee and ankle.  Sensation was intact but he had 1-2+ pitting edema along the anterior aspect of his leg.  There was tenderness over the tibia.  Motor strength was 5/5 but somewhat limited by pain.

At the 2 September 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported sharp pain twice a week that shot up his lower leg with standing activities that lasted 10-20 minutes.  He also complained of stiffness in the area of the pain.  He reported a history of swelling over the area of the fracture with running, but that had stopped because he no longer ran.  Walking long distances caused “tiredness of the leg.”  He was able to stand for “a couple of hours” before he began noticing pain.  He used an elastic lower extremity brace for support for about a year.  He reported no limitations in his ability to perform activities of daily living but was no longer able to run, jump or play competitive sports.  He was unemployed but denied that unemployment was due to his RLE condition.

Physical examination showed an obvious limping gait when walking to and from the examination room.  His muscle strength was 5/5 in the lower extremities.  Examination of the right tibia showed no swelling, redness or warmth of joints above or below the area of the stress fracture, but there was mild hypertrophy in the area of the mid-tibia approximately 12 cm below the knee that was slightly raised and painful.  There was strong musculoskeletal development bilaterally without atrophy.  There was no evidence of abnormal shoe wear.  He wore an elastic lower extremity support that fit from below the knee to the right ankle.  There was no leg length discrepancy or instability of tibia.  Standing on the toes and heel of his right foot elicited pain in the anterior tibia.  Dorsiflexion of the right foot also elicited pain in the anterior right mid-tibia region.  X-rays showed slight cortical thickening of the mid-distal tibia and fibula possibly representing a healed fracture.  There was no gross deformity of the contour of the bones.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the RLE condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing “no loss of motion of the contiguous joints.”  The VA rated the RLE condition 10%, coded 5262 (impairment of the tibia and fibula), citing “mal union of the tibia and fibula with slight knee or ankle disability.”  

The NARSUM noted the CI had significant pain for over a year from the stress fracture of the right tibia.  Examination showed swelling and tenderness over the right anterior tibia.  The CI had been unable to perform the duties of his MOS, run, or play sports during this period and had assumed new duties as a driver.  Repeat x-rays after almost a year showed a persistent stress fracture of the right tibia.  Right leg pain continued to restrict activity.  The panel concluded that the persistent stress fracture caused pain in the RLE that impaired function.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the RLE condition, coded 5299-5262 (slight ankle disability.) 

BOARD FINDINGS:  In the matter of the RLE condition, the panel majority recommends a disability rating of 10%, coded 5299-5262 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
RLE Pain	5299-5262	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016267, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure