RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02512
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060720

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

CI CONTENTION:  “I am currently rated at 30% overall for the left leg fracture and surgical scars that rendered me unfit for duty.  I am attaching my VA Award Letter with Decision Narrative to support my claim.”  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 - 20060705	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Leg Pain… 	5099-5003	0%	
No VA Examination Proximate to Separation in Evidence
	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:  

Chronic Left Leg Pain.    According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left leg pain began in August 2005 after falling down steps and sustaining left closed comminuted distal tibial and fibular shaft fractures.  On 26 August 2005, he underwent a closed reduction and intramedullary rod fixation of the left tibia, and an open reduction and internal fixation (ORIF) of the left fibula with plate and screws.  On 11 October 2005, X-rays showed healing of the distal tibia and fibular shaft fractures, status post ORIF with no hardware complications.  The CI attended physical therapy sessions postoperatively, and Thermopads for ankle pain due to metal in the bone were recommended.  An MRI dated 14 December 2005 showed loss of cartilage at the middle portion of the patella with loose bodies within the joint.  A moderate size knee effusion was identified as well as mild degenerative changes in the menisci.  Although the fibula appeared to be healed, the CI had pain in the tibial shaft region of the fracture after returning to basic training.  Imaging revealed tibial and fibular fracture fixation with persisting tibial diaphysis suggesting nonunion.  He then underwent left tibia nonunion takedown with iliac crest bone grafting and intramedullary nail screw removal on 10 March 2006.  After convalescent leave and physical therapy, the fracture appeared to heal, but he had persistent left and knee pain especially when going up and down stairs and with any kind of vigorous activity. 

The 22 May 2006 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of left leg and knee pain.  Physical examination showed well-healed incisions on the posterior aspect of the distal left calf and over the proximal anterior leg.  There was no erythema, ecchymosis, or swelling, and both the left knee and ankle had full symmetric range of motion (ROM) without pain.  He could perform a straight leg raise without difficulty, and motor strength was normal throughout the left lower extremity, with light touch sensation intact.  He had a prominent palpable callus on the distal aspect of the left leg at the junction between the middle and distal third of the tibia with mild tenderness in that area.  He walked with a slightly antalgic gait.  On the same day, X-rays showed the intramedullary nail to be intact and the fracture and callus continuing to consolidate.  A lucent line was no longer noted, and there was no angulation or displacement.   The fibula was well-healed and hardware was intact.  There was exuberant posterior callus on the tibia, which appeared to be bridging with the fibula.  The examiner’s diagnosis was persistent left leg and knee pain, status post left tibia fracture treated with intramedullary nailing and subsequent posterolateral iliac crest bone grafting and screw removal.  Left knee ROM was 0-136 degrees (normal 0-140) with mild discomfort at the end range of flexion.  Bilateral ankle ROM was normal with mild left ankle discomfort with dorsiflexion. During the 1 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported a “fib/tib fracture” and knee pain.  The examiner noted a surgical scar above the left ankle, and listed “fracture of the left tibia and fibula and non-union and posterolateral bone graft.”  There were no VA Compensation and Pension examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing chronic pain analogous to degenerative arthritis without significant joint motion.  Members agreed there was no limitation of flexion or extension of the knee or ankle that supported a rating under the VASRD diagnostic codes for limitation of motion (codes 5260, 5261 and 5271).  There was limited evidence of painful motion per se with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) since there was discomfort at the end of the ROM for both the left knee and ankle.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support ratings under those codes.  However, there was a history of a fracture, nonunion or malunion of the tibia as well as a fracture of the fibula with residual exuberant posterior callus on the tibia, to support a 10% rating for mild knee and ankle impairment related to long bone conditions (code 5299-5262).  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 chronic left leg pain, coded 5299-5262.  

BOARD FINDINGS:  In the matter of the left leg condition, the panel recommends a disability rating of 10%, coded 5262 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Leg Pain Following Tibia-Fibula Fracture	5299-5262	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007820, 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