RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04166
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060818

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Medical Specialist, medically separated for “chronic bilateral lower extremity pain” with a disability rating of 0%.

CI CONTENTION: Review requested of the lower extremity condition, which should have been rated higher.  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 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 - 20060523	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Bilateral Lower Extremity Pain	
5022	
0%	Right Lower Extremity Tibial Stress Reaction	5299-5262	10%	20070117	
			Left Lower Extremity Tibial Stress Reaction	5299-5262	10%	20070117	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Bilateral Lower Extremity Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced bilateral hip pain after road marches in February 2004 while in basic training. In April 2004, during advanced individual training, he developed lower leg pain, and a bone scan revealed stress reactions of the bilateral lower extremities. In August 2005, X-rays and a bone scan revealed stress reaction changes of the bilateral lower extremities to include the ankles and feet.

During the 17 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported constant bilateral knee and ankle pain which increased with activity and added weight. Physical examination showed mild tenderness over the mid tibial shafts with otherwise unremarkable findings. The 14 February 2006 MEB NARSUM examination noted complaints of intermittent pain from both knees down to the ankles, varying

from 2-8/10 in intensity, and worsened by prolonged standing, walking, running, climbing and carrying heavy objects. The examiner noted mild bilateral anterior knee, tibia, and ankle tenderness, full knee and ankle range of motion (ROM), and normal neurovascular findings.

At the 17 January 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported chronic leg pain exacerbated by physical activity. Localized pain was rated at 8/10, and occurred 3 times a day and lasted for an hour. Physical examination showed a normal gait and bilateral knee ROM from 0-140 degrees. After repetition, there was additional pain, weakness, lack of endurance and incoordination, which limited joint function by 10 degrees. Bilateral ankle ROM revealed dorsiflexion of 20 degrees (normal) and plantar flexion of 45 degrees (normal), after repetition, with no ROM loss, but function additionally limited by pain, weakness, and lack of endurance. Knee, tibia/fibula, ankle and foot X-rays were normal. The examiner recorded a diagnosis of “chronic bilateral leg and feet pain with tibial stress reactions with prolonged use. The subjective factors are pain, stiffness and limitations of legs after use. The suggestive objective finding is unequal leg length.”

The panel directed attention to its rating recommendation based on the above evidence. The PEB bundled the right and left lower extremity conditions and applied a single 0% disability rating, coded 5022 (periostitis), citing “full motion, stability and strength of all lower extremity joints. Rated for motion.” The VA rated the right and left lower extremity conditions 10% each, analogously coded 5299-5262 (impairment of tibia and fibula), based on the C&P examination, noting painful joint motion and citing sharp and aching lower extremity pain. In this case, both lower legs were profiled, implicated in the commander’s statement and NARSUM, and failed retention standards. Therefore, panel members agreed that each lower leg was unfitting. While the STR and NARSUM documented bilateral tibial stress reactions with tenderness, pain on use, and functional loss, the panel majority agreed that the VA examination was closest to separation and specified painful joint motion after repetition which caused limited knee ROM. In addition, all examinations supported a 10% rating, and no higher, for slight knee or ankle disability for each leg under code 5262. After due deliberation, considering all the evidence, the panel recommends a disability rating of 10% each for the right and left lower leg conditions, coded 5299-5262.

BOARD FINDINGS: In the matter of the bilateral lower leg condition, the panel majority recommends an unfitting right and left lower leg condition, each rated 10%, and coded 5299- 5262 IAW VASRD §4.71a. The single voter for dissent recommends no change and did not elect to submit a minority opinion. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Lower Extremity Pain	5299-5262	10%	
Left Lower Extremity Pain	5299-5262	10%	
	COMBINED	20%	

The following documentary evidence was considered:

AR20200002310, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,