RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03782
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060731

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Rifleman, medically separated for “stress fracture, left tibia” and “stress fracture, left femur,” rated 10% each, with a combined disability rating of 20%.

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 - 20060622	VARD - 20070801	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Left Tibia	5003-5262	10%	Left Knee Degenerative Changes with Tibial and Fibula Stress Fractures	5262-5010	10%	20070517	
Stress Fracture, Left Femur	5003-5255	10%	Left Femur Stress Fracture with Intermedullary Nail and Chronic Hip Pain	5255	10%	20070517	
Patellofemoral Dysfunction	Cat II	SEE ABOVE LEFT KNEE	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left Tibial Stress Fracture. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed a tibial stress fracture during basic training in October 2004. He was able to complete training and returned to full duty in November 2004, with the stress fracture considered healed.       However, around February 2005, he developed pain after

running, hiking or marching, and a bone scan showed an early stress fracture of the middle third of the left tibia. He underwent surgery in October 2005 for placement of intramedullary nails in both the left tibia and femur.

During the 8 April 2006 MEB NARSUM examination, 3 months prior to separation, the CI reported that while he no longer had tibial pain, could no longer perform his job duties or higher level physical training due to knee pain. Physical examination showed a normal gait and motor/sensory functions, and well-healed surgical incisions. Left knee range of motion (ROM) revealed flexion to 140 degrees (normal) with no pain. There was tenderness about the patella and the lateral joint line, but no thigh and leg tenderness with palpation.

At the 17 May 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported that due to the tibia condition he had knee pain which made him unable to run or stand/walk for prolonged periods of time. Physical examination of left tibia revealed normal findings. There was left knee joint effusion and flexion was to 100 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left tibia condition 10%, dual coded 5003-5262(arthritis, degenerative-tibia and fibula, impairment of). The VA rated the left knee with tibial and fibula stress fractures 10%, dual coded 5262-5010 (tibia and fibula, impairment of-arthritis, due to trauma, substantiated by X-ray findings), based on the C&P examination, citing painful, limited left knee motion. Panel members agreed that a 10% rating, but no higher, was justified for slight knee disability related to impairment of the tibia under code 5262.   Painful motion with functional loss based on   §4.59,
§4.40 and §4.45 was also applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI. Additionally, there was no limitation of flexion or extension (5260 or 5261); no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); and no recurrent subluxation or lateral instability to justify a rating under 5257 (knee, other impairment of). 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 left tibia condition.

Left Femur Stress Fracture. According to the STR and MEB NARSUM, the CI reported left thigh and leg pain starting in February 2005, and a bone scan in April 2005 revealed a femur stress fracture. As noted above, he had a femur intramedullary nail placement in October 2005. After several months of convalescent leave, he returned in January 2006 with no thigh or leg pain.

During the MEB NARSUM examination, the CI reported knee pain but no tibia or femur pain. Physical examination showed left hip flexion to 120 degrees (normal 125), without painful motion.   The thigh and leg were non-tender to palpation.

At the C&P examination, the CI reported that his femur condition had caused hip pain that occurred once a week and lasted the full day. He was unable to run, or stand/walk for prolonged periods. Physical examination showed unequal leg length (1.5 cm shorter on left) and an antalgic gait favoring the left leg, but no sign of abnormal weight bearing. There was left hip tenderness and guarding of movement with flexion to 100 degrees, but joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left femur condition 10%, dual coded 5003-5255 (arthritis, degenerative-femur, impairment of). The Navy PEB listed patellofemoral dysfunction as a related Category II (contributes to the unfitting condition, but not separately ratable), but panel members concluded the diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14. The VA rated the left femur and hip pain condition 10%, coded 5255, based on the C&P examination,

citing slight hip limitation of motion. The panel agreed there was no compensable limitation of flexion, extension or abduction (5251, 5252 or 5253); and no fracture, nonunion, or malunion of the femur to support a higher rating under code 5255. However, there was evidence of painful motion with limitation of motion to justify the 10% rating adjudicated by the PEB. 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 left femur condition.

BOARD FINDINGS: In the matter of the left tibial condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the left femur condition 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:

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 <ltd 25 Jul 19

1.	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 ofno 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.