RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01720
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Combat Trainee, medically separated for chronic leg pain with a disability rating of 0%.  

CI CONTENTION:  “Please 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 - 20051202	VARD - 20060207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Leg Pain, due to Healed Cortical Stress Reaction	5022	0%	Status Post Stress Fracture of the Right Mid-Tibia with Right Knee Strain 	5299-5262	10%	20051117	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Right Leg Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right leg condition began in May 2005 during basic training when he developed pain in his right leg without specific injury.  In June 2005 a bone scan showed a stress fracture of the right mid-tibia.  Radiographic studies in September 2005, 4 months prior to separation, showed an old, healed cortical stress reaction of the proximal tibia.  

During the 3 November 2005 MEB examination, 2 months prior to separation, the CI reported he continued to have pain.  Physical examination of the right leg showed tenderness along the medial tibia, but no swelling, neurovascular changes, or skin changes.  The examiner noted that the condition was stable and prognosis was good, but the CI was unable to do any aerobic activities to pass a PT test and therefore was unable to progress through basic training.

At the 17 November 2005 VA Compensation and Pension (C&P) examination, 1 ½ months before separation, the CI reported constant pain and inability to run or walk long distances.    The condition did not result in any time lost from work.  Physical examination showed his gait was within normal limits and he did not require an assistive device for ambulation.  Examination of the right tibia and fibula had normal findings; however, the right knee revealed swelling and crepitus.  Right knee range of motion (ROM) was flexion 135 degrees (normal 140) and extension 0 degrees (normal 0).  Painful motion was recorded.  There was no sign of meniscus problems.  Motor and sensory examination was within normal limits.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition 0%, coded 5022 (periostitis), citing no ratable limitation of motion.  The VA rated the right leg condition 10%, coded analogously to 5262 (tibia and fibula, impairment of), based on the C&P examination, citing status post stress fracture of the mid tibia with slight right knee disability.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no fracture, nonunion, or malunion of the tibia to support consideration under code 5262.  However, there was evidence of painful motion with functional loss supporting a 10% rating (IAW VASRD §§4.59, 4.40, and 4.45) based on the VA exam most proximate to separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right leg condition, coded 5022.  

BOARD FINDINGS:  In the matter of the right leg condition, the panel recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Leg Pain, Healed Cortical Stress Reaction	5022	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008171, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure