RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01901
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Signal Support Specialist, medically separated for “chronic lower extremity pain secondary to stress fractures of the bilateral tibias and right femoral shaft” with a disability rating of 0%. 

CI CONTENTION:  The CI contended her “original discharge for multiple stress fractures (tibia/fibia) injury caused substantial other injuries to become elevated/debilitating).”  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 - 20041221	VARD - 20050315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Extremity Pain Secondary to Stress Fractures of the Bilateral Tibias and Right Femoral Shaft	5022	0%	Bilateral Shin Splints with Stress Fractures of Both Tibias	5099-5002	0%	20050128	
			Stress Fracture, Right Femoral Shaft	5299-5255	0%	20050128	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:  

Chronic Lower Extremity Pain Secondary to Stress Fractures of the Bilateral Tibias and Right Femoral Shaft.  The PEB combined the left and right tibia and right femoral shaft stress fractures 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.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced shin pain during Advanced Individual Training in October 2003.  In January 2004 a bone scan revealed stress fractures of the shaft of the right femur and the shaft of both tibiae.  A second bone in April 2004 scan showed persistence of the stress fractures.  

The 9 November 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain in both legs, especially in the right thigh and knee.  Physical examination showed mild tenderness to palpation of the anterior tibial shafts as well as mild tenderness to palpation of the anterior right femoral shaft.  There was no swelling or effusion noted of the bilateral lower extremities.  Gait was normal.  Range of motion (ROM) of the ankles was plantarflexion of 40 degrees (normal 45) bilaterally and dorsiflexion of 15 degrees (normal 20) bilaterally.  ROM of the bilateral knees was flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  ROM of the right hip was flexion of 90 degrees (normal 125) and extension of 10 degrees (normal 20).  Painful motion was not recorded. 

At the 28 January 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, showed bilateral knee ROM of flexion to 125 degrees with pain and stiffness starting at 115 degrees and ending at 135 degrees.  Extension was 5 degrees with pain and stiffness starting at 0 degrees and ending at 10 degrees.  There was pain on palpation of both shins.

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB bundled the bilateral tibiae stress fractures with the femoral shaft stress fracture and applied a single 0% rating coded 5022 (periostitis), citing no significant loss of motion of the contiguous joints.  The VA rated the bilateral shin splints with stress fractures 0%, coded 5099-5002 (analogues to rheumatoid arthritis) based on the C&P examination, citing a non-compensable evaluation.  The panel first considered if each stress fracture, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  In this case, all of the stress fractures were profiled, considered to fail retention standards and implicated by the NARSUM and commander’s statement.  Panel members agreed that each stress fracture could be reasonably justified as separately unfitting.  

The panel then directed its attention to its rating recommendation.  The evidence did not support a 10% rating for painful motion with functional loss (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension of the knees (5260, 5261).  Although chronic stress fractures could be considered malunion of the tibia and fibula, they are not compensable IAW VASRD §4.71a unless there is 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 bilateral tibia and right femoral stress fractures.

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 20170301, w/atchs
Exhibit B.  Service Treatment Record	
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180005878, 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