RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01893
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “chronic bilateral leg pain” with a disability rating of 0%.  

CI CONTENTION:  The condition continues to worsen.  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 - 20070205	VARD - 20070531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Leg Pain	5099-5003	0%	Bilateral Patellofemoral Syndrome	5099-5020	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Bilateral Leg Pain.  The PEB combined the right and left knee and shin conditions under a single disability rating, coded analogously to 5003 (degenerative arthritis) 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.  

Bilateral Shin Splints.  According to the service treatment record (STR) and MEB narrative summary (NARSUM) the CI complained of right shin pain in March 2004; later, in December 2004, the CI complained of bilateral shin pain.  There was no history of trauma and his pain was attributed to running and ruck marching.  After a series of activity limiting profiles, including a permanent profile to limit physical fitness training and testing the CI’s symptoms persisted.  

During 5 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported stress fractures in both shins, but these were not substantiated by the STR.  Physical examination showed tenderness to the medial aspect of the left patella with no examination of the remainder of the lower extremities recorded.  

The 8 January 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of recurring bilateral leg pain in the anterior tibial shaft attributed to running, prolonged standing and marching.  Physical examination showed tenderness along the medial tibial ridge bilaterally.  The examiner referenced normal X-rays of both legs, dated 17 November 2006.  There was no VA examination proximate to separation in evidence.  

The panel first considered if the right and left shin splints, when decoupled from the combined PEB adjudication, remained separately unfitting as established above.  Both shins were considered to fail retention standards and were implicated in the NARSUM and the commander’s statement.  Since undue speculation would be required to conclude that impairment from either shin would not have unacceptably interfered with MOS performance, members agreed that each shin was reasonably justified as separately unfitting.  The panel then considered its rating recommendation for each unfitting shin based on the above evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB rated the combined right and left shin and knee conditions 0%, analogously coded 5099-5003, citing tenderness with palpation of the tibias and unremarkable X-ray studies.  The VA also rated the shin splints 0%, coded 5099-5020 (analogous to synovitis), based on the STR, citing no objective evidence of painful or limited motion.  

There was no evidence of nonunion or malunion of the tibia with any degree of knee or ankle disability in either leg to justify any rating under code 5262 (tibia and fibula, impairment of).  There was no evidence of limited ROM of the knee or ankle or evidence of painful motion to rate under any of the respective codes in either leg.  There was no evidence of weakness or limitation of dorsiflexion of either ankle or of any toes to justify a rating higher than slight (0%) coded 5312 (Group XII muscle injuries).  Antalgic gait was not recorded on any examination proximate to separation to provide evidence of painful motion with functional loss supporting a minimum 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral shin condition.  

Bilateral Patellofemoral Syndrome.  According to the STR and MEB NARSUM, the CI complained of occasional minor anterior knee pain in November 2006.  The 7 November 2006 orthopedic examination, 4 months prior to separation, noted complaints of occasional minor knee pain.  Physical examination of both knees showed normal motion without painful motion.  

During the 5 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI checked “knee trouble” and gave a history of a single episode of his knee “popping out” while running in 2005 but gave no history of current knee complaints.  Physical examination showed tenderness to the medial aspect of the left patella with no other pertinent examination findings of either knee.  

The 8 January 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of bilateral anterior knee pain aggravated by prolonged standing and marching.  Physical examination demonstrated full range of motion (ROM) of both knees with no tenderness and no pain on patellar compression.  At the 23 January 2007 MEB physical therapy ROM study of the knees, gait and posture were normal and flexion on the right was 131 degrees (normal 140) and 135 degrees on the left.  Extension was 0 degrees bilaterally (normal).  There was no record of painful motion.
 
The panel considered if the right and left knee conditions, when decoupled from the combined PEB adjudication, remained separately unfitting as established above.  Neither knee was profiled or implicated in the commander’s statement.  The STR evidence showed only intermittent symptoms of knee pain and there was no evidence of either knee being evaluated prior to 4 months prior to separation.  Therefore, the panel concluded that the preponderance of evidence showed the bilateral knee condition would not have caused the CI to be referred into the DES or to be found unfit.  After due deliberation, members agreed that the preponderance of evidence did not support a conclusion that the functional impairment from the bilateral knee condition was integral to the CI’s inability to perform his military occupation, and accordingly cannot recommend a separate rating for it.  

BOARD FINDINGS:  In the matter of the bilateral leg condition 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 20170312, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Records

AR20180005874, 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