RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02522
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic right lower extremity pain” with a disability rating of 10%.  

CI CONTENTION: No specific contention was made.  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 - 20061003	VARD - 20080318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Lower Extremity Pain	5099-5003	10%	Status Post (S/P) Right Tibia-Fibula Fracture	5262	20%	20080124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Lower Extremity Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s suffered open right distal tibia and fibula shaft fractures during a skateboarding accident on 1 May 2005.  He had a closed reduction with long-leg casting, but the reduction was lost in the cast.  After delayed union of the tibia, he underwent dynamization by removal of the distal interlocking screw in October 2005. He had a repeat reduction and fixation with intramedullary nailing on 10 May 2006, and the fracture appeared to heal over the next 6 months.  The 11 July 2006 MEB NARSUM orthopedic examination, 6 months prior to separation, noted CI complaints of persistent right knee, leg and ankle pain, as well as knee redness and swelling.  Leg X-rays showed further healing of the tibia fracture.  The examiner noted an antalgic gait, favoring the right leg, and no ankle or knee swelling.  Goniometrically measured range of motion (ROM) revealed flexion of 125 degrees (normal 140) and extension of 0 degrees (normal), with some difficulty and pain, compared to left knee ROM of 0-135 degrees.  Ankle ROM was 0-40 degrees bilaterally, with pain at the tibia facture site with resisted eversion.  There was slight warmth and tenderness around a prominent soft tissue mass over the anteromedial aspect of the right tibia plateau, and tenderness over the distal tibia fracture site.  Right ankle strength was 5/5.  

At the 24 January 2008 Compensation and Pension (C&P) examination, 13 months after separation, the CI reported constant pain in the entire right leg for which he took an over-the counter pain reliever once or twice a day.  He had a metal rod, which extended from the knee to the ankle, removed in December 2007, and experienced some stiffness after prolonged sitting, but resolved within 5 minutes of walking.  There was no locking, although he occasionally had a sensation of giving way, but with no falls; he did not use assistive devices.  He experienced some pain when using stairs, but was independent in all activities of daily living.  Physical examination showed a gait slightly favoring the right lower extremity due to pain.  Posture was erect and all movements were smooth.  Right knee flexion was to 110 degrees and extension to 0 degrees, with pain but with no change in motion after five repetitions.  Ankle ROM showed dorsiflexion of 10 degrees and plantar flexion of 50 degrees bilaterally, with no change after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right leg condition 10%, analogously coded 5099-5003 (arthritis, degenerative), with likely application of the US Army Physical Disability Agency pain policy, citing slight and frequent pain.  The VA rated the right leg condition 20%, coded 5262 (impairment of tibia and fibula), based on the C&P examination, citing moderate knee or ankle disability.  Panel members placed greater probative value on the NARSUM examination as it was more proximate to separation and the VA examination was 1 month after hardware removal.  The panel noted that while use of code 5262 was appropriate in this case for tibia and fibula fractures, documentation of a mild antalgic gait, near normal ROM and normal strength indicated a slight disability, which warranted a 10% rating and provided no benefit to the CI.  Painful motion also supported a 10% rating IAW §4.59.  After due deliberation, considering all 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 right leg condition. 

BOARD FINDINGS:  In the matter of the right 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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007821, 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.