RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03579
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Construction Equipment Repairer, medically separated for “bilateral tibial stress fractures” with a disability rating of 0%.

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 - 20060321	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tibial Stress Fractures	5022	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Bilateral Tibial Stress Fractures.  The PEB combined the right and left tibial conditions as a single unfitting condition, coded 5022 (periostitis) and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel also noted that “bundling,” the combining of two or more major joints may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral lower extremity condition began in December 1999 when he was diagnosed with shin splints.  A bone scan in May 2000 showed bilateral tibial stress fractures.  He deployed in March 2003 and was able to “tough” through the pain, however when he returned in March 2004, the pain continue to the point he was unable to move more than a few hundred yards with a fighting load or walk any distance without pain.  The 11 January 2005 physical therapy consultation noted active lower extremity range of motion (ROM) was within normal limits.  A bone scan completed in January 2006 showed continued tibial stress fractures.

During the 15 February 2006 MEB NARSUM examination, 3 months prior to separation, the CI complained of persistent shin pain.  Physical examination showed no decreased lower extremity ROM and good muscle tone, but there was pain on palpation of the tibial shafts.   The 24 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, revealed bilateral shin tenderness.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral tibial stress fractures 0%, coded 5022 (periostitis), citing no X-ray evidence or limitation of motion.  The panel first considered if the left and right lower extremity conditions remained separately unfitting as established above when de-coupled from the combined PEB adjudication.  The panel noted that both conditions were profiled and implicated in the commander’s statement as affecting duty performance.  The CI was treated for bilateral shin pain and bone scans noted bilateral tibial stress fractures.  The panel concluded there was not a preponderance of evidence that overcame the panel’s presumption that the left and right lower extremity conditions were reasonably considered separately unfitting.  The panel then considered its rating recommendation at the time of separation.  The evidence for coding and rating the right and left tibial conditions at separation is essentially identical and therefore both conditions are considered together in the panel’s ratings deliberations.

Although there was objective bone scan imaging of lower leg periostitis, there was no STR evidence of ankle limitation of motion (5271) to support a 10% rating for either leg, or a 20% bilateral rating under code 5003 (arthritis, degenerative).  The panel also considered and rejected a rating recommendation under code 5262 (tibia/fibula impairment) which requires ankle or knee disability related to long bone conditions.  The panel agreed there was no evidence of painful or limited motion on the physical therapy or MEB NARSUM examinations  Consequently there was no evidence to support a rating under code 5262.  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 bilateral lower extremity condition.  

BOARD FINDINGS:  In the matter of the bilateral tibial stress fractures 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.  

AR20180015289, 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.