RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03356
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080617

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “right tibial stress fracture” with a disability rating of 10%.

CI CONTENTION: His condition has worsened and is affecting his ability to find gainful employment. 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 - 20080506	VARD - 20080922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibial Stress Fracture	5299-5262	10%	Stress Fracture, Bilateral Tibias with Pain in Upper Legs	5299-5016	10%	2000819	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Tibial Stress Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right leg condition began in July 2007 during his fourth week of basic training. After 30 days of unit convalescent leave, he was placed in a physical therapy (PT) rehabilitation program and progressed well until January 2008 when the pain increased and the CI was no able longer to train. X-rays on 4 September 2007 showed no fracture or bony lesions involving the tibia or fibula of either leg. The joint spaces and soft tissues are normal. The impression was “normal legs.” The 27 February 2008 PT examination, 4 months prior to separation, the CI noted 4/10 pain at rest and 5-7/10 pain with activity.   Physical    examination

range of motion (ROM) showed flexion of 145 degrees (normal 140) and extension of 0 degrees (normal). The CI reported pain at the end ranges for right knee flexion and extension. The examiner stated the ROM was full with no mechanical limitations.

During the 28 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported a stress fracture of the right tibia and was seen at the in a medical clinic on 31 August 2007. Physical examination revealed a right tibial stress fracture. The examiner deferred to the consultant’s examination. The 31 March 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent pain, which he experienced “every morning when he awakes and rates his pain as 5/10.” Physical examination showed the CI had a normal gait and no indication of pain with ambulation. There was no swelling, instability, or tenderness along the tibial plateaus bilaterally, and no tenderness along the medial or lateral joint lines, however, the examiner noted “mild tenderness … along the mid- shaft of the right tibia.” Flexion was 135 degrees and extension was 0 degrees, bilaterally. Painful motion of the right knee was not noted.

At the 19 August 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported upper leg pain. Physical examination showed a normal gait. The neurovascular examination was within normal limits. The examiner noted calf tenderness and ROM measurements were not recorded.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right leg condition 10%, analogously coded 5299-5262 (impairment of tibia and fibula), citing functional loss due to pain. The VA rated the condition as a bilateral leg condition 10%, analogously coded 5299-5016 (osteitis deformans (Paget’s disease)) based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints. The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating.      However, with consideration of VASRD §4.3 (reasonable doubt) and
§4.7 (higher of two evaluations), there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45). After due deliberation, considering  all the evidence and mindful of VASRD §4.3, 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 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:

PD-2017-03356
AR20190010646, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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-2017-03356