RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00558 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060930

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aircraft Electrical Systems Technician, medically separated for “chronic bilateral medial tibial stress syndrome” with a disability rating of 0%.

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 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 - 20060712	VARD - 20070330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Medial Tibial Stress Syndrome	5022	0%	Left Tibial and Fibular Stress Fractures	5099-5262	10%	20060714	
			Right Tibial and Fibular Stress Fractures	5099-5262	10%	20060714	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Bilateral Medial Tibial Stress Syndrome. The PEB combined the right and left tibial stress syndrome conditions under a single disability rating, coded 5022 (periostitis) and rated 0%. 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.

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic bilateral medial tibial stress syndrome started with right leg pain and then progressed to bilateral tibial pain while running and without any specific trauma or injury. On 13 January 2005, X-rays demonstrated a healing stress fracture of the middle third of the right tibia shaft, and no fracture or subluxation of the left tibia. Leg X-rays in May 2005 were normal, but a bone scan showed healing stress fractures with shin splints in both tibiae. At an examination in July 2005, there was exquisite tenderness in the bilateral tibia, however X-rays showed no osseous abnormalities or evidence of healing stress fractures. An MRI in August 2005 showed bilateral shin splints and a bone scan in March 2006 showed linear uptake along the left and right posterior medial tibial shafts likely representing shin splints. Despite 8 months of limited light duty and physical therapy, no improvement was achieved, and there was no surgical solution for the chronic bilateral lower extremity condition.

At the 15 May 2006 MEB NARSUM examination, 4 months prior to separation, the CI complained of bilateral leg pain. Physical examination showed a well-developed, well-nourished woman in no apparent distress with a normal gait and no visible deformity of the legs, but extreme tibial tenderness. Bilateral knee and ankle range of motion (ROM) was full ROM with normal ankle strength noted. The 31 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808) revealed bilateral tibiae tenderness, but a normal gait.

At the 14 July 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported bilateral leg pain. Physical examination showed diffuse and marked tenderness to the right and left tibiae. The provider diagnosed bilateral medial tibial and fibular stress fractures with a moderate degree of pain and functional impairment.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral tibial stress condition 0%, coded 5022. The VA rated the left and right tibial conditions 10% each, analogously coded 5099-5262 (tibia and fibula impairment), based on the C&P examination, citing tenderness. Members first agreed that he evidence reasonably justified that the functional limitations of the left and right tibial stress conditions contributed to the CI’s inability to perform her military duties, and accordingly separate disability ratings are recommended. The panel noted the PEB rating was based on the use of code 5022, which refers to VASRD code 5003 rating rules. While imaging showed involvement of both tibias, a 10% rating was not warranted since there was no major joint involvement. Members then considered use of analogous code 5299-5262 for each leg, which is more appropriate for shin splints. However, while there was evidence of residual shin splints of both legs, there was no evidence of knee or ankle disability. After due deliberation, considering all 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 bilateral tibial stress syndrome.

BOARD FINDINGS: In the matter of the bilateral tibial stress syndrome 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 20170217, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 24 Oct 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.