RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02911
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070722

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Support Specialist, medically separated for “chronic pain, due to left tibial stress fracture” with a disability rating of 10%.  

CI CONTENTION:  Not all applicable medical information was considered in rating.  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 - 20070706	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Tibial Stress Fracture	5099-5003	10%	Left Tibial Stress Fracture	5299-5262	10%	20070306	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Tibial Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI initially injured his left heel and ankle in basic training.  A bone scan was negative for a fracture, although both heels showed increased uptake (consistent with stress).  X-rays in March 2005 showed changes consistent with a fracture.  In September 2005 orthopedics noted that current X-rays were normal, but an MRI and bone scan were consistent with a stress fracture of the left tibia (shin splint).  However, he was allowed to deploy.  An X-ray of the left ankle after redeployment in September 2006 was normal.  However, orthopedics noted calf atrophy and tenderness of the medial ankle.  A bone scan in October 2006 was consistent with a healed fracture.  

The 3 March 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant left lower extremity pain.  Physical examination showed a normal gait and posture.  The range of motion (ROM) was normal after repetition.  Tenderness was present over the left medial leg (not further defined) and heel-to-toe walking was painful and caused limping.  

The 6 March 2007 VA Compensation and Pension (C&P) examination mirrored the MEB NARSUM evaluation.  Formal ROM measurements in physical therapy on 5 June 2007 showed dorsi-flexion of 10 degrees on the non-affected right ankle and 11 degrees on the left (normal 20) and plantar flexion of 50 degrees bilaterally (normal 45).  The panel noted that the dorsiflexion on the left, while reduced from VA normal values, was actually slightly greater than the right side.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left lower extremity condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left lower extremity condition 10%, analogously coded 5299-5262 (tibia and fibula impairment), based on the C&P examination, citing “distal tibial stress fracture with residual painful motion causing a limp at times.”  The panel noted that code 5271, limited motion of the ankle, also supported a 10% rating, but there was no impairment to support a higher rating available under any applicable code.  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 the left tibial stress fracture.  

BOARD FINDINGS:  In the matter of the left tibial stress fracture 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 20170424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015209 XXXXXXXXXXXXXXXXXX

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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.