RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-03997
BRANCH OF SERVICE:  army	SEPARATION DATE:  20051229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic pain, due to left tibial stress fracture” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 - 20051130	VARD - 20060118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Due to Left Tibial Stress Fracture	5099-5003	10%	Left Leg Pain Due to Stress Fracture of the Upper Tibia	5099-5010	10%	20051117	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Tibial Stress Fracture Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left lower extremity pain began insidiously during advanced individual training.  A bone scan in July 2005 showed “left proximal tibial stress fracture,” and X-rays in August 2005 revealed a healing left tibial stress fracture.

During the 28 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, physical examination revealed tenderness over the upper one-third of the left tibia.  The 2 November 2005 MEB NARSUM examination noted CI complaints of leg pain despite activity modification, physical therapy and medications.  Physical examination showed a normal gait, but tenderness and slight swelling over the left upper one-third of the tibia.  Range of motion (ROM) was “full” in both lower extremities.  There was no redness or skin abnormalities, and lower extremity neurovascular findings were intact.

At the 17 November 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported left leg pain when standing, walking or running.  Physical examination showed a normal gait and no left leg edema, ulceration or stasis dermatitis.  Measured ROM revealed flexion to 140 degrees (normal) and extension to 0 (normal), without painful motion.  Left ankle dorsiflexion was to 20 degrees (normal) and plantar flexion to 40 degrees (normal 45).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left lower extremity condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight and constant pain IAW the US Army Physical Disability Agency pain policy. The VA also rated the left lower extremity condition 10%, but analogously coded 5099-5010 (traumatic arthritis), based on the C&P examination, citing painful motion of a major joint.  Panel members noted there was no compensable flexion or extension (5260 or 5261); history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); history of surgery to remove a meniscus (5259); or fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was also no compensable left ankle ROM limitation (5271).  However, 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 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left lower extremity condition.  

BOARD FINDINGS:  In the matter of the left lower extremity 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.   

	PD-2017-03997

AR20190011666, XXXXXXXXXXXXXXXXXXXXX 

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.

	PD-2017-03997