RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01069
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “right ankle”  and “left ankle,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  “I was given a low disability rating with the promise of severance pay vs. being retired.  I also still hurt…later found to have PTSD, TBI, vision problems, back problems, and hearing problems…”  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 - 20080604	VARD - 20090113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle	5299-5262	10%	S/P Left Shin Tibial/Fibula Stress Fractures w/ Left Knee Patellofemoral Pain Syndrome	5262	10%	20080812	
Right Ankle	5299-5262	10%	S/P Right Shin Tibial/Fibula Stress Fractures w/ Residuals	5262	10%	20080812	
Adjustment Disorder with Depressed Mood and Anger	Not Compensable
	Adjustment Disorder with Anxiety and Depressed Mood	9440	0%	20080812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle and Right Ankle Conditions (Presented as Chronic Bilateral Shin Pain).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral leg pain condition began in August 2005 after a combination of increased operational tempo and constantly carrying combat loads resulted in bilateral anterior shin pain.  The pain was treated with ibuprofen (a nonsteroidal anti-inflammatory drug (NSAID)), which did not provide relief and was discontinued due to gastric upset.  The symptoms gradually resolved with restrictions such as minimally strenuous work activities and physical training restrictions.  In February 2007, while the CI was preparing for another deployment, his symptoms returned.  At an orthopedic clinic visit on 11 January 2008 the CI reported pain in the left lower extremity worsened with increased activity.  On examination, there was a negative antalgic gait.  There was full active range of motion (ROM) of the bilateral lower extremities and tenderness of the anterior and posterior tibia.  There was no edema or erythema.  Muscle strength was intact; there was pain when testing dorsiflexion.  Treatment consisted of Mobic (an NSAID) and a no running profile for 90 days.  

At a physical therapy examination on 14 January 2008, 8 months prior to separation, gait was normal without any edema, effusion, or ecchymosis.  Sensation was intact in the lower extremities.  There was tenderness at the anterior and medial tibial borders at the middle half bilaterally.  The ROM was 23 degrees (normal 20) of forced dorsiflexion in weight bearing bilaterally.  All other motions were within normal limits.  Muscle strength was 5/5 throughout the knees and ankles.  Heel and toe walking were intact and there was mild pain with heel walking.  At an orthopedic clinic visit on 3 March 2008, 6 months prior to separation, the CI was able to add a stationary bike/elliptical to his treatment.  The CI was sent to physical therapy, but did not consider the treatment to be effective.  

During 13 March 2008 MEB examination (recorded on DD Forms 2807 and 2808), 6 months prior to separation, the CI reported numbness and tingling after prolonged walking and standing.  Physical examination showed bilateral tenderness of the medial mid shaft of the tibias.  The 29 April 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic bilateral leg pain/shin splints.  Physical examination was deferred to the MEB examination (as above) and focused examinations by orthopedics. 

At the 12 August 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported residual bilateral tibial pain with prolonged walking or prolonged stair climbing.  He was currently treated only with rest and stretching and used no assistive devices.  Physical examination showed an unremarkable examination without edema, deformity, or focal tenderness of the bilateral tibia and fibula.  Bilateral knee joints were stable.  ROM of the right knee was 120 degrees (normal 140) and the left knee ROM was 125 degrees.  The ROMs were felt to be normal for the CI.  Repetitive ROM testing by squatting maneuvers elicited no pain, no reduction in the ROMs, no fatigability, and no incoordination. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral shin pain right ankle condition 10% and left ankle condition 10%, each coded 5299-5262 (analogous to tibia and fibula, impairment of), citing risk of further injury with continued military training.  The VA separately rated the status post left and right shin tibial/fibula stress fractures conditions 10% each, coded 5262, based on the C&P examination, citing evidence of a functional impairment of the shins and knees with associated subjective complaints of primarily shin and knee pain with physical activity, and associated objective findings of slight limited knee motion, and past X-ray evidence of tibia/fibula fractures.

Members noted the PEB considered the condition to be chronic bilateral shin pain due to bilateral stress fractures of the tibia demonstrated by bone scan.  However, it rated each lower extremity using code 5299-5262, rated as the right ankle 10% and as the left ankle 10%, presumably based on an orthopedic examination on 11 January 2008 where there was pain on dorsiflexion.  Neither code 5262 nor any other code offer a route to a higher rating in the absence of moderate knee or ankle disability.  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 bilateral shin pain condition.  

Contended PEB Conditions.  Adjustment Disorder with Depressed Mood and Anger.  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 that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic bilateral shin pain due to bilateral stress fractures of the tibia condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with depressed mood and anger condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006636, 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