RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01626
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Special Communication Signals Operator, medically separated for “right tibial stress fracture” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 20040420	VARD - 20041203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibial Stress Fracture	5022-5003	10%	Stress Fracture, Right Leg	5299-5262	0%	20040830	
Bilateral Shin Splints	Cat II	Shin Splint, Left Leg	5299-5262	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Tibial Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right leg condition began in June 2001 as a result of running.  A note dated 5 June 2002 indicated the CI had a stress fracture of the right tibia diagnosed by a nuclear medicine study.  Physical examination revealed mild tenderness of the boot top of the right shin without edema or erythema (redness).  Physical therapy and light duty were initiated.  A bone scan dated 9 September 2003 demonstrated a right tibia grade I stress fracture which was consistent with shin splints.  Despite conservative treatment the CI’s pain condition could not be resolved.  

The 23 September 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of right shin pain.  Physical examination showed right tibia tenderness with no edema or erythema.  Strength of ankle dorsiflexion and plantar flexion was 5/5; the EHL (external hallucis longus) was 5/5; and flexion and extension of the knee was 5/5.  Sensation of the right leg was normal.  During the 15 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported a right leg stress fracture.  Physical examination showed right tibia tenderness.  A battalion aid station examination on 19 February 2004 showed continued right tibia tenderness.  During a sports medicine clinic visit on 12 April 2004 the CI reported no improvement with rest for 7 months and use of over-the-counter orthotics.  Physical examination showed right tibia pain.  Hip, fulcrum, and vibrator tests (to determine a tibia stress fracture) were positive.  

At the 30 August 2004 VA Compensation and Pension (C&P) general evaluation, 2 months after separation, the CI reported a stress fracture and bilateral shin splints with symptoms of dull pain on running or excessive walking.  The symptoms occurred intermittently and lasted for an hour.  Physical examination showed normal posture and gait.  Physical examination of both the right and left tibiae and fibulae were normal.  The feet had no signs of abnormal weight bearing and the CI did not require an assistive device for ambulation.  Knees and ankles were normal.  At a primary care visit on 17 March 2005, 8 months after separation, the CI reported having occasional pain symptoms.  Physical examination revealed right tibia tenderness.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition 10%, coded 5022-5003 (periostitis-arthritis, degenerative).  The Navy PEB listed bilateral shin splints as a related diagnosis (Category II) contributing to the Category I disability.  The panel concluded the right shin splints Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The panel also agreed that the left shin splint condition was diagnosed on a bone scan, but was not clinically evident or addressed on multiple examinations proximate to separation.  The panel determined that the left shin splint was not separately unfitting.  The VA rated the right leg condition 0%, analogously coded 5299-5262 (tibia, impairment) based on the C&P examination, citing an absence of malunion of the tibia and fibula with slight knee or ankle disability.

The panel first deliberated and agreed that the diagnosis of right tibial stress fracture (shin splint) coupled with the persistent right tibial tenderness is best represented under VASRD code 5022 (periostitis) at a 10% impairment rating.  There were no incapacitating exacerbations to warrant a 20% rating.  Alternatively, the panel considered a rating using code 5262 (tibia and fibula, impairment:  malunion) since there was a right tibia stress fracture.  However, there was no knee or ankle disability to warrant a rating higher than 0%, which offers no rating advantage 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 tibial stress fracture condition.

BOARD FINDINGS:  In the matter of the right tibial 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 20161024, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC

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