RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-03398
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20061203

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Communications and Intelligence Specialist, medically separated for “multiple stress fractures” with a disability rating of 0%.

CI CONTENTION: In addition to the stress fractures, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060922	VARD - 20070723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Stress Fractures	5099-5022	0%	Right Hip Bursitis (Residual Stress Fracture)	5019	10%	
20070223	
Femoral Shaft, Right	
Cat II					
Left Tibia		Left Tibia Stress Fracture	NSC		
First Metatarsal, Left		Left First Metatarsal Stress Fracture	NSC		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Multiple Stress Fractures. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially began to have pain in her left lower extremity while in Basic Training. A bone scan showed a stress reaction involving the middle third of the right femur, increased uptake involving the left tibia, middle third, and the left first metatarsal. An X-ray of the right hip was normal and showed no indication of a stress fracture involving the femoral neck.

DEXA scan and nerve conduction study of the left lower extremity were normal. She was placed on limited duty and advised not to run or do any strenuous physical activity.

The 30 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of discomfort involving the left lower extremity. She was dropped from training and placed in a hold status because of her persistent symptoms. Physical examination revealed a normal gait. Hips showed full range of motion (ROM) with no leg length discrepancy. Examination of the right thigh showed no palpable anomalies or areas of tenderness, but examination of the left anterior tibia showed tenderness, and there was minimal tenderness along the first metatarsal shaft. Neurovascular examination was normal bilaterally.

During the 1 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported left foot pain and tingling. Physical examination showed left lower leg tenderness with left foot metatarsal pain and paresthesia. The right hip and upper thigh had occasional pain with standing and ambulation.

At the 23 February 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain in the right hip and left foot that occurred three times per week and lasted for an hour. Pain was elicited by physical activity, but the CI was able to function without medication. The CI was not receiving any treatment. The CI reported pain in the left shin one time per week lasting an hour. It was also elicited by physical activity, and the CI could function without medication. The CI also reported bilateral hip pain due to stress fractures. It occurred three times per week, was relieved by itself and was not incapacitating. The CI could function without medication and was receiving no treatment. Physical examination showed a normal gait and the right and left femur, tibia and fibula showed no abnormalities. However, both the right and left hip showed signs of tenderness and joint function was additionally limited by pain after repetitive use, although ROM was full bilaterally. Left hip extension showed pain at 25 degrees. Right and left leg length was equal. X-rays of the feet, right femur, left tibia and bilateral hips were all within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the multiple stress fractures 0%, analogously coded 5099-5022 (periostitis). The Navy PEB listed right femoral shaft, left tibia and left first metatarsal as related diagnoses (Category II) contributing to the disability in this case. The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA did not have a rating for multiple stress fractures but rated the Cat II condition, femoral shaft, right 10%, coded 5019 (bursitis), based on the STR and VA C&P examinations, citing painful or limited motion of a major joint or group of minor joints. The VA found the Cat II left tibia and first metatarsal to be not service connected.

The NARSUM examination showed no evidence of painful motion involving any lower extremity joint. X-rays showed healed lower extremity fractures. The C&P examination noted pain was intermittent and relieved by rest. The CI did not require medication and was able to function with pain. As noted in the NARSUM examination and confirmed by the C&P examination, duty limitations would likely result in resolution of the condition (multiple stress fractures). After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the multiple stress fractures.

BOARD FINDINGS: In the matter of the multiple stress fractures and IAW VASRD §4.71, the panel majority  recommends  no  change  in  the    PEB  adjudication.	The  single  voter  for   dissent

recommended modification to 10% but did not elect to submit a minority opinion. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO,
1850
CORB: 003 20May20

From:

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 21 May 19

I.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.