RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00539
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20061215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic leg (left) pain secondary to chronic stress fractures” with a disability rating of 0%.

CI CONTENTION:  Current condition supports a higher rating.  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 - 20061004	VARD - 20070330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Leg (Left) Pain	5099-5022	0%	Left Leg Stress Fracture	5099-5022	0%	20070316	
COMBINED RATING: 0	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Left Leg Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left leg condition began in May 2004 after he stepped in a pothole during a unit run.  A bone scan showed a grade II stress fracture of the left tibia and bilateral shin splints.  Despite conservative treatment he was unable to walk one mile before the pain became severe, and could not be further rehabilitated to meet the physical requirements of his military specialty; therefore, he was referred to the MEB.

During the 28 August 2006 MEB NARSUM examination, 4 months prior to separation, the CI reported pain with running a half mile.  Physical examination showed the left leg without erythema or edema.  There was no tibial tenderness.  Pain was noted in the bottom portion of the leg during dorsiflexion of the foot and milder pain with inversion/eversion of the foot.  Walking on his toes and heels did not cause any pain or discomfort, but hopping on the left lower extremity caused severe left tibia pain.  Knee or ankle range of motion (ROM) were not addressed.

At the 16 March 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported left lower tibia pain and discomfort with running.  Physical examination showed a normal gait and no left tibia tenderness. There was no joint involvement or muscular weakness, and no swelling, effusion, tenderness, muscle spasm, joint laxity, muscle atrophy, fibrosis, or bony residual of fracture.  There were no foot neurological problems and no joint ankylosis.  Specific ROM was not specified.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition 0%, analogously coded 5099-5022 (periostitis), citing tibial tenderness, negative X-rays, and a positive bone scan showing tibial stress fractures.  The VA also rated the left leg condition 0%, analogously coded 5099-5022, based on the C&P examination, citing a lack of objective evidence of painful or limited motion of a major joint or group of minor joints and no tenderness.  The panel placed greater probative value on the VA examination more proximate to the date of separation.  The panel agreed there was a positive bone scan, but no tibia tenderness, limitation of motion or painful motion to support a rating under code 5022 or IAW VASRD §4.59 and §4.40 (painful motion and functional loss).  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 chronic left leg pain condition.

BOARD FINDINGS:  In the matter of the chronic 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.  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 20170210, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004701, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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