RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02674
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Information Technology Specialist, medically separated for “right hip pain” and “left leg tibial stress fracture,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “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 - 20090410	20091023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain 	5299-5255	10%	Right Hip Strain	5299-5255	10%	20090812	
Left Leg Tibial Stress Fracture	5299-5262	10%	Shin Splints, Left Leg	5299-5262	10%	20090812	
Stress Changes Right Tibia	Not Unfitting	Shin Splints, Right Leg	5299-5262	NSC	20090812	
Stress Changes Bilateral Tibial Plateaus						
Stress Changes Bilateral Ankles		Bilateral Ankle Strain	5299-5271	NSC	2009-812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right hip condition began in June 2008 without specific trauma or injury.  X-rays showed a linear fracture in the right inferior pubic ramus.  After a 30 day profile, radiographic studies showed a healing stress fracture but the pain continued.  A bone scan showed stress fractures in the right inferior pubic ramus and left tibia, with stress related changes in the right tibia, both tibial plateaus and both ankles.  Conservative treatment was not successful in resolving the pain.  An X-ray on 16 January 2009 revealed a healed fracture of the right inferior pubic ramus and well preserved joint spaces.  

The 23 March 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of right hip pain, especially with running.  Physical examination showed full right hip range of motion (ROM), in degrees, with flexion of 120 (normal 125), extension of 10 (normal 30) and abduction of 35 (normal 45) which was symmetric to the opposite side and noted as full ROM with pain by the examiner.  There was no change following repetition.  The CI was able to cross his legs bilaterally.  There was no hip or groin tenderness and strength in the lower extremities was normal bilaterally.  The right knee had ROM of 0-130 degrees (normal 0-140) which was symmetric to the opposite side and noted as normal full ROM by the examiner.  

At the 12 August 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right hip pain.  Physical examination showed a normal gait without right hip tenderness.  Right hip ROM was flexion of 90 degrees, extension of 30 degrees and abduction of 30 degrees; painful motion was present with no decrease following repetition.  The CI was able to cross legs and toe out greater than 15 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5299-5255 (femur, impairment of), citing slight functional hip or knee disability.  The VA also rated the right hip condition 10%, analogously coded 5299-5255, based on the C&P examination, citing slight knee or hip disability.  There was no compensable limitation of hip motion under codes 5250 through 5253.  However, there was clear objective evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45) at the NARSUM and C&P examinations.  All examinations supported a 10% rating analogous to code 5255 for slight hip disability.  There was insufficient evidence for the next higher moderate hip disability level.  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 hip condition.  

Left Leg Tibial Stress Fracture.  According to the STR and MEB NARSUM, the CI’s left leg condition began in late June 2008 after over compensating for right hip pain.  X‑ray findings in July 2008 and bone scan in November 2008 were consistent with left mid-tibial stress fracture.  X-rays in January 2009 showed no acute bony abnormalities.  The 23 March 2009 MEB NARSUM examination, 2 month prior to separation, noted complaints of pain in the left tibia, especially with running or impact activities.  Physical examination revealed left knee ROM of 0-130 degrees (normal 0-140); left ankle ROM testing showed dorsiflexion of 20 degrees (normal) and plantar flexion of 40 degrees (normal 45).  The knee and ankle ROMs were symmetric to the opposite side and noted as normal full ROM by the examiner, with no change following repetition for either joint.  

At the 12 August 2009 VA C&P examination, 3 months after separation, the CI reported left tibia and ankle pain.  Physical examination showed a normal gait.  Left ankle ROM testing showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees with pain at end ROM and no change following repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition 10%, analogously coded 5299-5262 (tibia and fibula, impairment of), citing slight knee or ankle disability.  The VA also rated the left leg condition 10%, analogously coded 5299-5262, based on the C&P examination, citing slight knee or ankle disability.  There was no limitation of knee or ankle motion which supported a rating under the diagnostic codes for limitation of knee flexion or extension or ankle motion (5260, 5261 or 5271).  However, there was NARSUM and C&P examination evidence of slight knee or ankle disability supporting the 10% rating as adjudicated by the PEB.  There was insufficient evidence for the next higher moderate knee or ankle disability level.  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 left leg condition.  

Contended PEB Conditions:  Stress Changes in Right Tibia, Stress Changes in Bilateral Tibial Plateaus and Stress Changes in Bilateral Ankles.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  All of the conditions were profiled and non-specifically implicated in the commander’s statement who referred to the general profile restrictions; however, none were judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left leg condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended stress changes in the right tibia, bilateral tibial plateaus and bilateral ankles, the panel recommends no change from the PEB determinations as not unfitting.  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 20170423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007826, 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.