RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE:  PD-2017	-04412
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20070210
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Store Keeper, medically separated for “bilateral lower extremity [BLE] tibia periostitis/chronic stress fractures” with a disability rating of 10%.
CI CONTENTION: No specific contention was made. 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 - 20061206	VARD - 20071107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
BLE Tibia Periostitis and Chronic Stress Fractures	5262	10%	Residuals, Tibia Periostitis/ Chronic Stress Fracture/Chronic Pain, Right Lower Extremity	5399-
5312	10%	20070822	
			Residuals, Tibia Periostitis/ Chronic Stress Fracture/Chronic Pain, Left Lower Extremity	5399-
5312	10%	20070822	
BLE Pain	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Bilateral Tibia Periostitis/Chronic Stress Fractures. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s leg problems began in 2005 after jumping off a truck. She was subsequently diagnosed with reflex sympathetic dystrophy (complex regional pain syndrome) and a possible right tibial stress fracture. The 2 November 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of “pain and tightness with occasional paresthesia which occur[red] shortly after beginning high-impact loading, prolonged walking, or even sometimes just prolonged standing-type activities.” The MEB physical examination (recorded on DD Form 2808), the following day, revealed normal BLE appearance and range of motion. At the 22 August 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported bilateral leg weakness and pain with exercise and prolonged standing and walking, as well as coldness and tingling of the feet. Physical examination revealed normal gait, BLE strength, and neurologic findings.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the BLE condition 10%, analogously coded 5299-5262 (impairment of the tibia), and listed BLE pain as a related Category II condition, which the panel noted to be part and parcel of the unfitting tibia periostitis/chronic stress fractures, with any disability appropriately subsumed in the rating of the primary unfitting condition. The VA rated the right and left lower extremity conditions 10% each, analogously coded 5399-5310 (group X muscle injury), based on the C&P examination, citing moderate muscle disability. Panel members first considered whether each leg, having been de-coupled from the combined PEB adjudication, remained separately unfitting. In this case, both legs were profiled and implicated by the NARSUM and non-medical assessment, and both failed medical retention standards. The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that each leg was reasonably considered separately unfitting. Panel members then considered rating recommendations for the unfitting left and right lower extremity conditions at the time of separation, but the panel majority found no compensable limitation of flexion or extension (5260 or 5261), and no objective findings of pain, swelling , or muscle spasms (based on §4.59, §4.40 and §4.45) for either leg under code 5022 (periostitis). 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 and right lower extremity conditions.

BOARD FINDINGS: In the matter of the bilateral lower extremity condition and IAW VASRD
§4.71a, the panel majority recommends no change in the PEB adjudication. The single voter for dissent recommends modification to 20% (10% for each leg), but did not elect to submit a minority opinion. 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:

2	PD-2017-04412

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
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.