RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2016-01590
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Electronics and Mechanical Equipment Repairer, medically separated for “status post tibia stress fractures both lower extremities” with a disability rating of 10%.  

CI CONTENTION:  No specific contention 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040324	VARD - 20040804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Tibia Stress Fractures Both Lower Extremities	5022-5003	10%	Bilateral Tibial Fractures / Shin Splints	5299-5262	NSC	20040707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Status Post Tibia Stress Fractures.  The PEB combined the right and left tibia stress fracture conditions under a single disability rating, dual coded 5022-5003 (periostitis- arthritis, degenerative) and rated 10%.  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 noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  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 right and left tibia stress fracture conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral leg condition began in late 2001 or early 2002 after increased running and prolonged standing.  He was initially diagnosed with shin splints and a September 2003 bone scan demonstrated bilateral tibial stress fractures.  Six months of limited duty decreased but did not resolve his symptoms; there was no surgical indication.  

The 16 December 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued bilateral shin pain with only about 20% improvement with medication, orthotics and limited duty.  There was no physical examination.  During the 23 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported intermittent pain and pressure in both lower legs over the previous 2 or 3 years.  Physical examination revealed normal lower extremities.  

At the 7 July 2004 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported bilateral tibial pain that increased with walking, but that he was able to walk an unrestricted distance.  Bilateral tibia X-rays were normal and the examiner concluded there was no current evidence of stress fracture residuals.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg condition 10%, dual coded 5022-5003.  The VA determined the bilateral leg condition was not service connected (NSC), analogously coded as 5262 (tibia and fibula, impairment of), based on the C&P examination, citing no chronic residual disabilities were found at the VA examination.  

The panel first considered if the right and left tibia stress fractures, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Every visit was for both shins and the LIMDU report listed bilateral tibial stress fractures as the unfitting diagnosis.  Since undue speculation would be required to conclude impairment from either shin would not have unacceptably interfered with duty performance, members agreed each tibia was reasonably justified as separately unfitting.  

The panel then directed attention to its rating recommendation for each unfitting tibia based on the above evidence.  There was no evidence of nonunion or malunion of either tibia to justify a 10% or higher rating using code 5262, and no other applicable codes available for rating consideration.  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 status post tibia stress fracture condition.  

BOARD FINDINGS:  In the matter of the status post tibia stress fracture condition and IAW VASRD §4.71a, the panel 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record   

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

							XXXXXXXXXXXXXXXXXX
	     				                        Assistant General Counsel
						           (Manpower and Reserve Affairs)