RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01020
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20041208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantry, Gun Crews and Seamanship Specialist, medically separated for “bilateral tibial shaft stress fractures” with a disability rating of 0%.

CI CONTENTION:  CI contended for several other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) be reviewed.  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 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 - 20041028	VARD - 20050713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Shaft Stress Fractures	5003-5262	0%	Residuals of Stress Fracture, Left Tibia	5299-5262	0%	20050602	
	5003-5262	0%	Residuals of Stress Fracture, Right Tibia	5299-5262	0%	20050602	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Tibial Shaft Stress Fractures.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral tibial shaft stress fractures initially presented in May 2004 as bilateral shin pain.  A bone scan revealed findings consistent with bilateral stress fractures and or stress reactions about the shafts of both tibiae.  The 15 September 2004 MEB NARSUM examination, 3 months prior to separation, revealed tenderness about the middle of both tibias.  A repeat bone scan revealed “bilateral tibial stress fractures, proximally.”  Clinical encounters on 18 October and 1 November 2004 continued to note bilateral tibial tenderness upon physical examination.  
At the 2 June 2005 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported bilateral mid-leg pain.  On examination, there was slight tenderness over the front aspect of both tibias.  Radiographs of the lower extremities revealed no fractures, dislocations or bony erosions.  The examiner recorded that the tibial stress fractures were well-healed. 

The panel directed attention to its rating recommendation based on the above evidence.  Although the PEB documented “bilateral tibial shaft stress fractures” they provided separate impairment ratings for right and left lower extremities at 0% each, dual coded as 5003-5262 (degenerative arthritis-impairment of tibia and fibula).  The VA also rated the bilateral lower extremity conditions at 0% each, coded analogously as 5262, (impairment of tibia and fibula), based upon the C&P examination 6 months after separation, citing the absence of malunion of the tibia and fibula with slight knee or ankle disability.  Panel members considered the physical findings in conjunction with the time of separation and concluded that the adverse findings in the October and November 2004 clinical encounters coupled with improved but still consistent with “slight” symptoms at 6 months after separation was sufficient in determining a positive impairment rating near separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel recommends separate right and left disability ratings of 10% each and coded as periostitis  (5022) for the bilateral lower leg condition. 

BOARD FINDINGS:  In the matter of the bilateral lower extremity condition, the panel unanimously recommends separate disability ratings of 10% for each lower extremity, coded 5022 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Tibial Stress Fracture	5022	10%	
Right Tibial Stress Fracture 	5022	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 13 Oct 17 ICO XXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 06 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 06 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 10 percent) effective date of discharge.       

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent rating (increased from 10 percent) effective date of discharge.  

     g. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.   

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.
	
     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                                  	XXXXXXXXXXXXXXXXXX
                                 	Acting