RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05420
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060314

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 “bilateral leg pain,” with a disability rating of 0%.   

CI CONTENTION:  Running in boots during Air Force basic training made his leg conditions worse.  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 - 20060303	VARD - 20060821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Leg Pain	5099-5003	0%	Stress Reaction of the Right Medial Tibial Plateau	5099-5262	10%	20060607	
			Stress Reaction of the Left Medial Tibial Plateau	5099-5262	0%	20060607	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Leg Pain.  The PEB combined the left and right leg conditions under a single disability rating, coded analogously to 5003 (arthritis, degenerative) and rated 0% with application of the US Army Physical Disability Agency (USAPDA).  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral leg pain condition is presented with attendant recommendations regarding separate unfitness, and separate rating if indicated

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral leg condition began in October 2005 after a fall.  Radiographic studies from 11 October 2005 were normal and showed no arthritis or structural abnormalities.  At the 21 October 2005 physical therapy examination, 5 months prior to separation, the CI reported dull 4/10 pain in both knees.  The range of motion (ROM) was noted as normal.  The 19 January 2006 primary care medical clinic examination, 2 months prior to separation, noted complaints of right knee pain.  Physical examination showed full ROM.  

The 25 January 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of diffuse pain going down the legs and having to shift at night because of the pain.  The pain was worse after working a 6-hour duty day, ascending and descending stairs or inclined surfaces and after sitting for greater than ten minutes.  Physical examination showed full active ROM of both knees.  Tenderness was noted over the patellar tendons as well as diffusely along the anteromedial tibial shaft.  There was positive medial facet tenderness and positive patellofemoral compression present.  He had no ecchymosis, erythema, effusion or edema.  Tests for ligamentous instability were negative.  There was no joint line tenderness.  A bone scan showed increased uptake in the medial tibial plateaus which indicated stress reactions.  There were also focal areas of increased uptake in the feet and ankles indicating stress reactions.  The orthopedic examination on the same day, noted full ROM in the legs, no ecchymosis, erythema, edema or effusion but showed diffuse tenderness along the anterior medial tibia.  

At the 7 June 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant aching pain located at the lateral and medial edges of the right more than left knee.  He also reported popping sounds, right knee locking and both knees giving out.  Precipitating/aggravating factors included physical activities such as standing, walking and climbing stairs.  Physical examination of the knees showed ROM with flexion of 140 degrees (normal) and extension of 0 degrees (normal), but there was evidence of popping and painful motion in the right knee.  There was no evidence of weakness, lack of endurance with repetitive use, redness, swelling, instability or abnormal movement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral leg condition 0%, coded analogously as 5003, citing full active ROM of all associated joints without instability, rated as slight and occasional pain IAW the USAPDA pain policy.  The VA rated the right leg condition 10%, coded analogously as 5262 (impairment of tibia and fibula), based on the C&P examination, citing malunion of the tibia and fibula with slight knee or ankle disability.  The VA rated the left leg condition 0%, coded analogously as 5262, based on the C&P examination, citing the absence of malunion of the tibia and fibula with slight knee or ankle disability.  

The panel first considered if the right and left leg conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel noted there was scant evidence to rate the right and left leg as separately unfitting, as they were not mentioned separately in the commander’s comments, nor addressed separately in the clinical notes and they were not profiled separately.  The NARSUM details of the bilateral condition did not differential between the left or right leg.  The panel concluded that the bilateral leg condition could not be separated for individual contributions to fitness and separate disability ratings.  

The panel then considered its rating recommendation for the unfitting bilateral leg pain condition at the time of separation.  The panel noted that the ROM at the time of the MEB and VA examinations was normal and therefore did not attain a minimum rating under VASRD diagnostic code 5271.  The panel considered coding the conditions as 5299-5262, analogous to tibia impairment, which is an analogous code for shin splints.  There was evidence that the bone scan was consistent with mild bilateral shin splints and painful motion to support a 10% rating for the bilateral leg condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the leg conditions, coded 5262.  

BOARD FINDINGS:  In the matter of the bilateral leg condition, the panel recommends a disability rating of 10%, coded 5262 IAW VASRD §4.71a.  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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Leg Pain	5262	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007402, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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,					      
Enclosure