RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01322
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20040618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Airman Basic, medically separated for “stress fracture right tibia” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20040609	VARD - 20050520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibia Stress Fracture	5262	10%	Stress Fracture Lower Extremities	5299-5262	0%	20040719	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:  

Right Tibia Stress Fracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented with bilateral knee pain on 12 November 2003 during the third week of basic training, 5 days after falling down several stairs and landing on her hands and knees.  She was treated with medications, stretching exercises and duty limitations.  She did not improve and was then placed on medical hold and referred to physical therapy.  She noted marked improvement and was returned to training on 1 December 2003.  Within a few weeks her knee pain recurred and she returned to medical hold status.  Knee X-rays on 12 February 2004 revealed stress fractures of the bilateral medial tibial plateaus; these X-rays were not in evidence.  A bone scan on 6 April 2004 showed Grade I stress fracture of the right tibial plateau and left 1st metatarsal, which was asymptomatic, and bilateral feet, left ankle and left knee stress changes.  During the 6 May 2004 MEB NARSUM examination, 1 month prior to separation, physical examination showed a tender right tibial plateau (bottom of the knee) and positive right patellar (kneecap) grind.  The examination was otherwise unremarkable.  

At the 19 July 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported chronic pain at the infrapatellar region of both knees, both ankles, and occasionally at the anterior groins of both hips; there were no specific flare-ups.  The bilateral ankle range of motion (ROM) was normal.  Knee ROM was bilateral extension to 0 degrees (normal), and right flexion was to 132 degrees while the left was 136 degrees; bilateral painful motion was elicited.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right tibia stress fracture condition 10%, coded 5262 (tibia and fibula, impairment, malunion, with slight knee or ankle disability).  The VA rated the stress fracture lower extremities condition 0%, analogously coded 5299-5262, based on the C&P examination 1 month after separation, citing absence of tibia and fibula malunion with slight knee or ankle disability.  The panel agreed there was no compensable loss of motion.  Other coding options offered no 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 right tibia stress fracture condition.

BOARD FINDINGS:  In the matter of the right tibia stress fracture 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.  Therefore, the panel recommends 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 20160927, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01322.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings