RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00659
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Radio Operator Maintainer, medically separated for “pain in lower left leg” with a disability rating of 0%.   

CI CONTENTION:  Condition continues 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 - 20040630	VARD - 20060321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain in Lower Left Leg	5033-5099	0%	Status Post Left Tibia Stress Fracture…	5262	30%	20050926 	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lower Left Leg Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left leg condition began during basic training as a result of marching.  She was diagnosed with a stress fracture of the left proximal tibia and continued to have pain despite profiles; serial imaging showed a slowly or poorly healing stress fracture.  The 12 January 2004 orthopedic examination noted continued tibial/fibular pain with tenderness of the left medial proximal tibia and diagnosed nonunion of the stress fracture.  

During the 17 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation the CI reported her history of a fracture. Physical examination showed a prominent area over the proximal medial tibia that was mildly tender.  The 12 January 2004 MEB NARSUM examination, 9 months prior to separation, noted the CI was not able to perform heavy manual labor, but was capable of performing clerical duties.  She was given a permanent profile in January 2004 with an alternate bicycle test for physical fitness testing.  She was not taking any medications for the condition.  Physical examination showed no discoloration or gross malalignment.  There was a palpable tender enlargement of the mid-aspect of the left tibia and tenderness of the proximal medial tibial plateau.  The CI’s “hip, knee, and ankle” were normal.  

There was no VA Compensation and Pension evaluation in the record, however, the original VA Rating Decision summarized a 26 September 2005 orthopedic medical report, 11 months after separation.  The CI reported left tibial complaints when climbing stairs, walking, and with sports activities.  Physical examination showed a “free and flexible” gait.  There was slight shortening of the left leg, noted to be 1 cm and a slight decrease in muscle bulk compared to the right (circumference decrease of 1 cm).  There was “free” left knee and ankle movement noted, both active and passive.  There was slight “crus vara position” (inward bowing) of both legs.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition 0%, analogously coded 5033-5099 (there is no VASRD 5033 code), citing tibia stress fracture.  The VA rated the left leg condition 30%, coded 5262, (tibia and fibula impairment), based on the orthopedic medical report 11 months after separation, citing malunion of the tibia and fibula with marked knee or ankle disability.  

The panel noted there is no 5033 code in the VASRD and assumed the PEB’s code was a clerical error likely meant to be analogous to 5003 (degenerative arthritis), as was noted on the original PEB Form 199, prior to an administrative correction.  There was no evidence of painful limited motion of the left knee or ankle with imaging evidence of pathology for 10% rating under the 5003 or related codes. There was no evidence of painful motion of either knee or ankle supporting a 10% rating 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).  An analogous rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula and ankle) was considered.  There was evidence of malunion or nonunion of the tibial stress fracture.  However, as noted above there was no objective knee or ankle disability documented to support greater than a 0% rating with this code.  The threshold for a 10% rating for leg shortening (3.2 to 5.1 cm) was also not met in this case.  There was therefore no higher rating than 0% available under any applicable VASRD code.  Although there is no VASRD 5033 code, the panel does not recommend a change to the PEB’s code unless there is an associated ratings benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left leg pain condition.  

BOARD FINDINGS:  In the matter of the lower left leg pain 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 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016346, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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