RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03145 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090529

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “right mid-tibial stress fracture” and “left side shin splints,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Her rating was inaccurate and should be higher because the conditions have worsened despite chiropractic care and therapy.  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 – 20090310	VARD - 20090402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Mid-Tibial Stress Fracture	5299-5262	10%	Stress Fracture and Shin Splints, Right Tibia	5299-5262	0%	20090319	
Left Side Shin Splint	5099-5022	10%	Shin Splints, Left Tibia	5299-5262	0%	20090319	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	
	
ANALYSIS SUMMARY:

Right Mid-Tibial Stress Fracture/Left Side Shin Splint. According to the service treatment record and MEB narrative summary (NARSUM), the CI developed a right mid tibial stress fracture in October 2007 after running and activity. A whole body scan on 7 May 2008 revealed a healing right mid tibia stress fracture and mild shin splint in the left tibia. The 9 February 2009 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of shin pain rated at 4-

6 /10. Physical examination showed no effusion and lateral tenderness of the right patellae. Bilateral knee range of motion (ROM) was limited to 115 degrees (normal 145) of flexion and full extension.  Right and left ankle dorsiflexion was to 20 degrees (normal) and plantar flexion to  40 degrees (normal 45).

At the 19 March 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported bilateral stress fractures and shin pain with any type of cardio exercise. Physical examination revealed a normal gait, and no focal tenderness, heat, or joint effusion.  Right and left knee ROM was from 0-130 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating for each lower extremity, analogously coded 5299-5262 (tibia and fibula, impairment of) for the right, and 5099-5022 (periostitis) for the left, citing functional loss due to shin pain with prolonged weight-bearing and impact activities IAW VASRD §4.10,   §4.40,
§4.45 and §4.59. The VA rated each lower extremity 0%, analogously coded 5299-5262 (tibia and fibula, impairment of), based on the C&P examination. Panel members agreed there was no compensable rating for limitation of flexion or extension (5260, 5261) in either lower extremity. However, there was evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45). Additionally, there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); and no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). There was therefore no VASRD §4.71a rating higher than the 10% for either lower extremity as adjudicated by the PEB under any applicable code. 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 tibial stress fracture and left shin splint.

BOARD FINDINGS: In the matter of the right mid-tibial stress fracture and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the left shin splint 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:

PD-2017-03145 

[AR NUMBER], XXXXXXXXXXXXXXXXX 

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.

Enclosure

PD-2017-03145