RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03945
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Information System Management Specialist, medically separated for “bilateral shin splints with stress fractures of left lower shin and right foot” with a disability rating of 0%.

CI CONTENTION:  “Severe fracture in left tibia and stress fracture in both feet.”  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 - 20060828	VARD - 20070919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints, Stress Fractures of Left Lower Shin and Right Foot	5099-5003	0%	Left Leg Stress Fracture and Bilateral Shin Splints	5299-5262	NSC	20070608	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Shin Splints with Stress Fractures Left Lower Shin and Right Foot.   According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral shin splints condition began in August 2005 following a mountain run.  Bone scan showed stress fractures of the left lower shin and within the right foot.  In March 2006, the CI continued to have pain in the left shin during a diagnostic fitness test, but was able to participate in a 4-mile ruck march in April 2006.  During the ruck march she developed left foot pain and was referred to the MEB.

During 13 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported, “I have had stress fractures in both feet for over a year.”  She noted that she used orthotics. Physical examination showed mild tenderness over the left heel and mid anterior ankle, and normal arches in the feet.

The same-day MEB NARSUM examination noted complaints of constant pain in the left foot, mainly in the area of the calcaneus that was exacerbated with running, walking, climbing stairs, or walking barefooted or in boots.  Physical examination showed normal appearing ankles.  There was no tenderness, muscle spasms, pain on motion, or instability of the ankles, and no pain with motion of the foot.  Range of motion (ROM) of left ankle documented dorsiflexion of 10 degrees (normal 20) and plantar flexion of 45 (normal), compared to right ankle with 15 degrees of dorsiflexion and normal plantar flexion.  Despite the examiner’s statement of absence of pain on motion, it was later stated that the CI “had minimal pain during ROM measurements in the ankles.”  The diagnosis rendered was left foot stress fractures complicated by pain during normal activities.

At the 8 June 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported a history of left tibia stress fracture that bothered her when walking or standing more than 30 minutes.  The CI reported she was unable to run but could walk one mile daily.  The examiner noted that the CI’s left stress fracture and left ankle pain had resolved, and that she had not had ankle, or left tibial pain for one year.  She denied current symptoms.  Physical examination of the left ankle showed ROM with dorsiflexion to 20 degrees and plantar flexion of 45 degrees.  Painful motion was absent, and there was no evidence of ankle instability.  There was no evidence that the right extremity or foot was examined. Gait was normal without any functional limitations.  The examiner assessed normal left ankle, left leg and foot stress fracture, and resolved tibia and shin splints.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral shin splints with stress fractures of the left lower shin and right foot condition 0%, analogously coded as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA did not service connect the conditions of left ankle, left leg stress fracture and bilateral shin splints, citing normal examinations of the left ankle, left leg and left foot, and resolution of the shin splints.

Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 the panel must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for service rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  

The panel proceeded to the rating of the left leg shin splint, with stress fracture.  The NARSUM documented the single complaint of pain in the left foot.  There was no mention of left ankle pain.  The foot and ankle exam findings were unclear.  It was initially stated that there was absence of tenderness and pain on motion or instability, but later the examiner contradicted the statement, by stating, there was minimal pain on motion.  The C&P examination documented the conditions had completely resolved and the left extremity examination was normal.  Panel members concluded that the C&P examination had the greater probative value as it was more comprehensive, and had better internal consistency.  Post-separation STR showed repeated normal examinations of the left ankle, and no diagnosis of a left lower extremity condition.  Additionally, the 20 December 2005 physical therapy evaluation stated that the left leg pain had resolved and the right foot pain started as the result of more weight being placed on it.  The panel agreed the left shin splint with stress fracture condition did not rise to a level of compensability under §4.59, §4.45 or §4.40.  

The panel next proceeded to consider a rating for the right shin splint condition.  The panel noted the absence of right leg findings.  Tenderness was not recorded during the NARSUM or C&P examinations and ROM was essentially full.  There was no documentation of pain on motion, limitation of motion, or functional loss.  There were no radiographic findings of degenerative joint disease.  None of the above noted examinations recorded objective evidence of right leg/ankle worse than the left, and the right shin splint was not profiled.  After deliberation, the panel concluded the record in evidence did not support the minimal compensable rating for right shin splint condition under any coding option.  The panel agreed the right shin splint condition did not rise to a level of compensability under §4.59, §4.45 or §4.40.  

The panel next considered the right foot condition, but found no evidence to support a compensable rating for this condition.  The panel noted there was no mention of the right foot in the NARSUM or C&P examinations.  The CI did not report any problems with the right foot.  The ROM of the right ankle was mildly decreased and there was no evidence of pain on motion or functional loss due to right foot limitation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB adjudication for the bilateral shin splint and right foot conditions.  The panel further noted, there was no additional benefit to the CI when the conditions were unbundled, therefore, the PEB appropriately combined the conditions.

BOARD FINDINGS:  In the matter of the bilateral shin splints with stress fractures of the left lower shin and right foot condition and IAW VASRD §4.71 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.  

AR20180016665, 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.