RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00770
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090513

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Trainee, medically separated for “bilateral tibia plateau and left medial aspect stress fractures” with a disability rating of 20%.  

CI CONTENTION:  He should get a medical retirement for his back and knee injuries.  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 - 20090417	VARD - 20090811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibia Plateau and Left Medial Aspect Stress Fractures	5299-5262	20%	Stress Fracture of Left Tibia with Oblique Shaft of the Fibula	5311	NSC	STR	
			Stress Fracture of the Right Tibia	5399-5311	NSC	STR	
Mechanical LBP	Not Unfitting	Mechanical LBP	5237	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Tibia Plateau and Left Medial Aspect Stress Fractures.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI developed knee pain in October 2008 during basic training without specific injury or trauma.  X-rays were normal, but a bone scan showed increased uptake consistent with bilateral tibial plateau (knee) stress fractures, bilateral shin splints and a separate left medial tibial stress fracture.  Repeat X-rays on 2 February 2009 showed evidence of a healing stress fracture of the right medial plateau which correlated with the bone scan, but X-rays were normal on the left and repeat X-rays on 2 March 2009 were normal bilaterally.  

At the 24 March 2009 MEB NARSUM examination by orthopedics, 2 months prior to separation, the CI reported constant bilateral knee pain.  On examination, motion was painful and limited on the right knee to 130 degrees of flexion (normal 140) and painful and limited on the left to 129 degrees.  The gait was normal and the knees were otherwise unremarkable.  Tenderness was present along the left tibial shaft (shin).  The knee and leg pain was expected to resolve over time.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left leg stress fractures 10% each, coded 5299-5262 (analogous to impairment of the tibia and fibula), citing functional loss with prolonged activity and impact activities.  The VA did not service-connect the right and left leg stress fractures, citing no permanent residual or chronic disability subject to service connection had been established.  The rating decision noted that the CI did not report for his VA examination.  

The X-rays most proximal to separation were normal and the limitation of motion was not compensable for either knee, although painful.  Tenderness was present over the left shin, but the gait and X-rays were normal.  The evidence supported a rating of 0% at separation for each knee.  However, the panel does not recommend a lower combined rating than that adjudicated by the PEB.  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 either of the right leg stress fracture.  

Contended PEB Condition:  Mechanical Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right leg stress fracture and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left leg stress fracture and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended back condition, the panel agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends there be 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 20170220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004899, 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